Pharmacoeconomic Aspects Of Fluoroquinolone Usage

Fluoroquinolone antibacterial agents are expensive, especially when administered intravenously. In some indications, such as Gram-negative or polymicrobial osteomyelitis (where oral fluoroquinolone therapy can replace lengthy intravenous therapy) and enteric fevers (where the excellent clinical results and low incidence of carriage states are clearly superior to standard therapy), the benefits outweigh the additional cost. Oral fluoroquinolones are also among the agents of choice for IV-oral switch (stepdown) therapy [82-84]. Thus, Gentry and colleagues found IV-to-oral ofloxacin therapy effective for both nosocomial and community-acquired pneumonia [85].

In other indications, cost-acquisition comparison with other agents may at first sight appear unfavorable. However, when true cost-efficacy and cost-benefit studies are undertaken that effectively measure total costs—including intravenous drug preparation and administration, hospitalization and complication rates, potential for early discharge, reduced time lost from work—and subjective elements—such as quality of life, especially using IV-oral switch regimens— fluoroquinolone therapy can be a highly cost-effective proposition [84,86,87]. For example, sequential therapy using ciprofloxacin substitution after initial intravenous therapy may reduce drug costs by 45% and hospitalization costs by 20% [82]. Specific comparisons with ceftazidime and imipenem in nosocomial and severe pneumonia showed ciprofloxacin therapy to save more than US $500 per treatment [88] and to significantly reduce posttreatment days in hospital, further antibiotic costs, and repeat hospitalization [89]. In acute exacerbations of chronic bronchitis, a year-long follow-up study found oral ciprofloxacin to achieve cost savings compared to standard regimens in patients with risk factors for poor outcomes [90].

These potential savings also apply with other agents and have resulted in fluoroquinolones (e.g., ofloxacin [83]) being incorporated into IV-oral switch guidelines. Controlled use of levofloxacin in a critical pathway resulted in reduced admission rates, decreased use of resources, and shorter hospital stays compared with conventional management [91].

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