Tags

Type your tag names separated by a space and hit enter

Once-daily cefepime versus ceftriaxone for nursing home-acquired pneumonia.
J Am Geriatr Soc. 2007 May; 55(5):651-7.JA

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 dollars for cefepime- and 215+/-68 dollars for ceftriaxone-treated patients (P<.001). Cost-effectiveness analysis of total costs showed that cefepime would cost 597 dollars and ceftriaxone 1,709 dollars 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.

Authors+Show Affiliations

CPL Associates, LLC, Amherst, Buffalo, NY 14226, USA. paladino@cplassociates.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17493183

Citation

Paladino, Joseph A., et al. "Once-daily Cefepime Versus Ceftriaxone for Nursing Home-acquired Pneumonia." Journal of the American Geriatrics Society, vol. 55, no. 5, 2007, pp. 651-7.
Paladino JA, Eubanks DA, Adelman MH, et al. Once-daily cefepime versus ceftriaxone for nursing home-acquired pneumonia. J Am Geriatr Soc. 2007;55(5):651-7.
Paladino, J. A., Eubanks, D. A., Adelman, M. H., & Schentag, J. J. (2007). Once-daily cefepime versus ceftriaxone for nursing home-acquired pneumonia. Journal of the American Geriatrics Society, 55(5), 651-7.
Paladino JA, et al. Once-daily Cefepime Versus Ceftriaxone for Nursing Home-acquired Pneumonia. J Am Geriatr Soc. 2007;55(5):651-7. PubMed PMID: 17493183.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Once-daily cefepime versus ceftriaxone for nursing home-acquired pneumonia. AU - Paladino,Joseph A, AU - Eubanks,David A, AU - Adelman,Martin H, AU - Schentag,Jerome J, PY - 2007/5/12/pubmed PY - 2007/6/8/medline PY - 2007/5/12/entrez SP - 651 EP - 7 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 55 IS - 5 N2 - 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 dollars for cefepime- and 215+/-68 dollars for ceftriaxone-treated patients (P<.001). Cost-effectiveness analysis of total costs showed that cefepime would cost 597 dollars and ceftriaxone 1,709 dollars 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. SN - 0002-8614 UR - https://www.unboundmedicine.com/medline/citation/17493183/Once_daily_cefepime_versus_ceftriaxone_for_nursing_home_acquired_pneumonia_ L2 - https://doi.org/10.1111/j.1532-5415.2007.01152.x DB - PRIME DP - Unbound Medicine ER -