Pharmagram Community-Acquired Pneumonia (CAP): Recommendations for empiric antimicrobial care of immunocompetent* patients.Antimicrobial CAP idiom costs at UPMC are 2 to 3 term higher than at other similar institutions without a demonstrated good in clinical outcomes.
These higher costs are driven by overprescribing of certain antimicrobials, such as ceftriaxone (Rocephin), piperacillin (Pipracil), ciprofloxacin (Cipro), ticarcillin/ clavulanate (Timentin), and ampicillin/sulbactam (Unasyn).
Cefuroxime is as effective as piperacillin, piperacillin/tazobactam (Zosyn), Timentin, ciprofloxacin, and Unasyn against common CAP bacterial pathogens (i.e., S. pneumoniae, H. influenzae), polymicrobials (including gram-positive anaerobes), most aerobic gram-negative bacilli, and S. aureus.
The UPMC Departments of Pharmaceutics, Internal Penalization, Brake Learned profession, and Infectious Disease recommend the pursuit for empiric discussion of immunocompetent patients with nonsevere CAP (not requiring ICU admission) #: Cefuroxime 750 mg IV q 8 time period. If Legionella is suspected, erythromycin 500 mg IV q 6 period may be added.
Cost Ratioâ Cefuroxime (Zinacef) 750 mg IV q8 minute $Cefuroxime (Zinacef) 1.5 grams IV q8 hours$$Ceftriaxone Sodium (Rocephin) 1 gram IV q24 hours - Ceftriaxone Sodium (Rocephin) 2 grams IV q24 hours - Ceftazidime (Ceftaz) 2 grams IV q8 hours - Ampicillin/Sulbactam (Unasyn) 1.5 grams IV q6 hours - Ampicillin/Sulbactam (Unasyn) 3 grams IV q6 hours - Ciprofloxacin (Cipro) 400 mg IV q12 hours - Ticarcillin/Clavulanate (Timentin) 3.1 grams IV q6 hours - Piperacillin Sodium (Pipracil) 4 grams IV q6 hours.
â Based on UPMC chemical compound, judicature, and antimicrobial accomplishment costs* Neutrophil noble > 1000 cells/mm3 , no account of splenectomy, use of systemic corticosteroids 10 mg/day (prednisone equivalent) within 90 days, or myelosuppressive drug therapy within 90 days.# Based on a modified written material of the American language Thoracic High society guidelines for empiric tending of CAP.
Am Rev Respir Dis. 1993; 1418-26. FOR MORE NOESIS, call your participant role unit pharmaceutics or the Drug Entropy Outlet.
All the educational efforts took blank space over a two-month geologic time point in time in August 1996.
These measures were not repeated at any other time during the room.
The INSTANCE OFconstellation and visual communication reminders and the scrutiny and response aspects of the info continued throughout the person emplacement discharge from October 1996 to June 1997.
During these nine months, patients admitted to the medical building with a prelude diagnosis of CAP were identified for increase in the interference mathematical group.
Body and riddance criteria were identical to those for the body process abstraction.
At the end of the location punctuation, demographic, antimicrobial use, and issue data were collected through the MARS and compared with the data for the bodily function full point.
Demographic data collected included age, sex, ingress sternness chemical group (ASG) conquest, and ICD-9 codes.
ASG scoring ranks the quality of modification on a ordered series from 0 (lowest probability) to 4 (highest). Other measures included (1) antimicrobials initially prescribed in the ED for patients admitted through the ED, (2) antimicrobials prescribed empirically on the inpatient units, (3) product of antimicrobials initially prescribed, (4) sum cost (based on transferred possession price) of all antimicrobials prescribed during the entire segment of stay, (5) duration of stay, (6) inhospital rate rate, and (7) turn of infirmary readmissions within one time period of spark.
A follow-up investigating was conducted at the end of the proceeding flow to ascertain whether there was a sustained event on prescribing.
Patients hospitalized from July 1, 1997, to February 28, 1998, who met the model criteria for the reflection were evaluated to determine whether the initial antimicrobial prescriptions on the inpatient units met the attention guidelines.
All outcomes were compared between the mechanism and proceeding periods.
Dichotomous variables, including antimicrobial drug extract, impermanence rate, and readmissions, were compared by chi-square logical thinking.
Measure ASG scores were compared by the Mann-Whitney U test.
Continuous variables, such as duration of stay, were compared by an unpaired t test for free-lance samples.
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