JAC Advance Access originally published online on January 6, 2003
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Journal of Antimicrobial Chemotherapy (2003) 51, 391-396
© 2003 The British Society for Antimicrobial Chemotherapy
Cost-minimization analysis and audit of antibiotic management of bone and joint infections with ambulatory teicoplanin, in-patient care or outpatient oral linezolid therapy
1 Infection and Immunodeficiency Unit, Ward 42, East Block, 2 Pharmacy and 3 Orthopaedic Infection Unit, Ninewells Hospital and Medical School, Tayside University Hospitals NHS Trust (TUHT), Dundee, UK
Received 4 July 2002; returned 11 September 2002; revised 19 October 2002; accepted 27 October 2002
Bone and joint infections are significant causes of morbidity, mortality and healthcare costs. The cost of treatment for such infections is driven primarily by the length of hospital stay. Many of these infections will require treatment with prolonged periods of parenteral antibiotic therapy. Clinicians and healthcare managers are being attracted increasingly by administering treatment in the ambulatory setting as this offers clinical, economic and quality of life advantages from both the hospital’s and patient’s perspective. Our retrospective audit of managing 55 treatment episodes of bone and joint infections with teicoplanin delivered in the outpatient or home setting revealed that the mean cost of care per episode of infection was less with treatment in the ambulatory setting (£1749.15) compared with the in-patient setting (£11 400) or compared with the hypothetical situation of treatment with oral linezolid in the home setting (£2546). Teicoplanin therapeutic drug monitoring appears to be valuable in establishing optimal serum levels, which appear to correlate with good clinical outcomes. The potential for alternative day or thrice weekly dosing with teicoplanin may offer further cost advantages whilst maintaining equivalent clinical effectiveness.
Keywords: teicoplanin, linezolid, bone and joint infection, therapeutic drug monitoring, cost minimization
* Corresponding author. Tel: +44-1382-660111; Fax: +44-1382-496547; E-mail: dilip.nathwani{at}tuht.scot.nhs.uk
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