Once-daily cefepime versus ceftriaxone for nursing home-acquired pneumonia.

摘要: 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 home-acquired pneumonia. INTERVENTION Cultures were obtained, patients randomized to or 1 g intramuscularly every 24 hours. MEASUREMENTS Clinical success: cure improvement. Cure was defined as complete resolution of all symptoms signs pneumonia a return the patient's baseline state. Improvement clear improvement but incomplete pretherapy usual status. Safety pharmacoeconomics also assessed. RESULTS Sixty-nine randomized; 61 evaluable: (32 cefepime, 29 ceftriaxone). Patients predominately female (76%). They had mean age+/-standard deviation 85+/-6, 5.8+/-1.9 comorbidities; they age-appropriate renal dysfunction, estimated creatinine clearance 35+/-7 mL/min. success occurred in 78% cefepime- 66% ceftriaxone-treated (P=.39). Fifty-seven (93%) switched oral antibiotics after 3 days. Antibiotic-related adverse events 5% patients. Seven (11.5%) hospitalized. The overall mortality rate 8%. Mean antibiotic costs 117+/-40 dollars for 215+/-68 (P<.001). Cost-effectiveness analysis total showed that would cost 597 1,709 per expected successfully treated patient. One- two-way sensitivity analyses using generic price improving its comparative efficacy revealed results robust. CONCLUSIONS Once-daily cost-effective alternative treatment elderly home residents who developed did not require hospitalization.