Imipenem/cilastatin versus gentamicin/clindamycin: a cost effectiveness study

A previously published clinical trial was used for analysis of costs for antibiotic treatment in patients with serious bacterial infections requiring the use of injectable broad spectrum antibiotics. The patients were randomized to receive imipenem/cilastatin 500/500 mg q6h (77 patients of which 56 were evaluable for efficacy) or clindamycin 600 mg q6h plus gentamicin 1.5 mg/kg with dose intervals determined by serum concentration monitoring (86 patients of which 62 were evaluable for efficacy). An analysis of the costs for antibiotics, including drugs, equipment and staff for administration and gentamicin serum concentration assays, showed that imipenem/cilastatin was not more expensive than gentamicin plus clindamycin per treatment day although the drug cost was considerably higher for imipenem/cilastatin. Since imipenem/cilastatin was significantly more effective and caused less frequent adverse reactions than gentamicin plus clindamycin it was more cost-effective in the patients studied.