Get access

Once-Daily Cefepime Versus Ceftriaxone for Nursing Home–Acquired Pneumonia

Authors

  • Joseph A. Paladino PharmD,

    1. From the *CPL Associates, LLC, Amherst, New YorkSchool of Pharmacy and Pharmaceutical SciencesSchool of Medicine, University at Buffalo, State University of New York, Buffalo, New York§Elder Medical Services, Buffalo, New York.
    Search for more papers by this author
  • David A. Eubanks MD,

    1. From the *CPL Associates, LLC, Amherst, New YorkSchool of Pharmacy and Pharmaceutical SciencesSchool of Medicine, University at Buffalo, State University of New York, Buffalo, New York§Elder Medical Services, Buffalo, New York.
    Search for more papers by this author
  • Martin H. Adelman PhD,

    1. From the *CPL Associates, LLC, Amherst, New YorkSchool of Pharmacy and Pharmaceutical SciencesSchool of Medicine, University at Buffalo, State University of New York, Buffalo, New York§Elder Medical Services, Buffalo, New York.
    Search for more papers by this author
  • Jerome J. Schentag PharmD

    1. From the *CPL Associates, LLC, Amherst, New YorkSchool of Pharmacy and Pharmaceutical SciencesSchool of Medicine, University at Buffalo, State University of New York, Buffalo, New York§Elder Medical Services, Buffalo, New York.
    Search for more papers by this author

  • Presented in part at the 42nd Annual Meeting of the Infectious Diseases Society of America, Boston, Massachusetts, October 1, 2004, Abstract 288, and the 45th Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, DC, December 16, 2005, Abstract O-188.

Address correspondence to Dr. Joseph Paladino, CPL Associates, LLC, 3980 Sheridan Drive, Suite 501, Buffalo, NY 14226. E-mail: paladino@cplassociates.com

Abstract

OBJECTIVES: To compare once-daily intramuscular cefepime with ceftriaxone controls.

DESIGN: Double-blind study.

SETTING: Six skilled nursing facilities.

PARTICIPANTS: Residents aged 60 and older with nursing home–acquired pneumonia.

INTERVENTION: Cultures were obtained, and patients were randomized to cefepime or ceftriaxone 1 g intramuscularly every 24 hours.

MEASUREMENTS: Clinical success: cure or improvement. Cure was defined as complete resolution of all symptoms and signs of pneumonia or a return to the patient's baseline state. Improvement was defined as clear improvement but incomplete resolution of all pretherapy symptoms or signs or incomplete return to the patient's usual baseline status. Safety and pharmacoeconomics were also assessed.

RESULTS: Sixty-nine patients were randomized; 61 were evaluable: (32 to cefepime, 29 ceftriaxone). Patients were predominately female (76%). They had a mean age±standard deviation of 85±6, with a mean 5.8±1.9 comorbidities; they had age-appropriate renal dysfunction, with a mean estimated creatinine clearance of 35±7 mL/min. Clinical success occurred in 78% of cefepime- and 66% of ceftriaxone-treated patients (P=.39). Fifty-seven patients (93%) were switched to oral antibiotics after 3 days. Antibiotic-related adverse events occurred in 5% of patients. Seven patients (11.5%) were hospitalized. The overall mortality rate was 8%. Mean antibiotic costs were $117±40 for cefepime- and $215±68 for ceftriaxone-treated patients (P<.001). Cost-effectiveness analysis of total costs showed that cefepime would cost $597 and ceftriaxone $1,709 per expected successfully treated patient. One- and two-way sensitivity analyses using a generic price for ceftriaxone and improving its comparative efficacy revealed that the results were robust.

CONCLUSIONS: Once-daily cefepime was a cost-effective alternative to ceftriaxone for the treatment of elderly nursing home residents who developed pneumonia and did not require hospitalization.

Ancillary