JAC Advance Access published online on January 6, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg061
© 2003 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Infection and Immunodeficiency
Unit, Ward 42, East Block, Ninewells Hospital and Medical School, Tayside University Hospitals
NHS Trust (TUHT), Dundee, UK
* Corresponding author. E-mail: dilip.nathwani{at}tuht.scot.nhs.uk.
Received 4 July 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
Cost-minimization analysis and audit of antibiotic
management of bone and joint infections with ambulatory teicoplanin,
in-patient care or outpatient oral linezolid therapy
2 Pharmacy, Ninewells Hospital and Medical School, Tayside University Hospitals
NHS Trust (TUHT), Dundee, UK
3 Orthopaedic Infection
Unit,
Ninewells Hospital and Medical School, Tayside University Hospitals
NHS Trust (TUHT), Dundee, UK
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