Lege Artis Medicinae

[The choice of antibiotic therapy from the viewpoint of an economist]

KIS Zoltán

DECEMBER 21, 2011

Lege Artis Medicinae - 2011;21(12)

[OBJECTIVES - Antimicrobial resistance (AMR) in various bacterial infections is a growing problem in everyday clinical practice. The development of resistance is related to the clinical use of antibiotics, which substantially influences the efficiency of antimicrobial therapy. Inappropriately chosen therapy may increase the cost of treatment because of reduced efficacy and potential unwanted outcomes, adverse effects. Prolonged duration of treatment and increased use of diagnostic and therapeutic resources (including all medication expenses) contribute to the increased costs of treatment. The aim of our study was to demonstrate the differences in the total cost of therapy during hospitalization in certain patient groups, depending on the efficiency of the chosen antibiotic therapy. METHODS - We examined acute abdominal episodes, which represent one of the most typical surgical diseases. We analysed 59 hospital in-patient episodes that occurred in a six-month period, using aggregated hospital data. On the basis of the first choice of antibiotic we compared the average duration of antibiotic therapy and hospital stay, the incidence of medical complications and the cost of all these factors. RESULTS - The available results of our pilot study show that the length of hospital stay and the total cost of treatment may substantially increase even in the short term as a result of an inadequate choice of antibiotic, as the total cost of treatment is affected not only by the daily cost of antibiotic therapy, but also by its efficiency. In the long term, the risk of potentially developing resistance also necessitates an accurate choice of therapy, which requires institutional infection control and the prescription and implementation of protocols. These must be supported by cost-effectiveness analyses that include costs as well as results.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Christmas in Medicine ]

KISS László

Lege Artis Medicinae

[Social Responsibilities of a Physician ]

SÓLYOM Antal, BÁLINT Géza

Lege Artis Medicinae

[A Tame Artist Among the ‘Wild”: The Life and Art of Rik Wouters]

NÉMETH István

Lege Artis Medicinae

[On the borderline]

KAPÓCS Gábor

Lege Artis Medicinae

[They are really saved]

FARSANG Csaba

All articles in the issue

Related contents

Clinical Neuroscience

[The role of anaerobic bacteria in brain abscesses: a literature review]

URBÁN Edit, GAJDÁCS Márió

[Brain abscesses are potentially serious, life-threatening diseases that pose a complex diagnostic challenge not only to neurosurgeons but also to clinical microbiologists, neurologists, psychiatrists, infectologists. The etiology of brain abscess is usually polymicrobial, most commonly involving a variety of aerobic and obligate anaerobic bacteria. Epidemiological studies on the anaerobic etiology of brain abscesses are common between the time period of 1960s and 1980s, but today there are very few new publications on the subject. The role of anaerobic bacteria in this disease was presumably underdiagnosed for a very long time, as many laboratories did not have the adequate laboratory capabilities for their cultivation and identification. The purpose of this review is to summarize the available literature on the etiology of obligate anaerobic bacteria in brain abscesses, including their prevalence and current therapeutic recommendations.]

Clinical Neuroscience

[Prevention of invasive meningococcal infection, recognition and first treatment of the disease in primary care]

KOVÁCS Ákos, KULCSÁR Andrea, KALABAY László, TORZSA Péter

[Neisseria meningitidis, the meningococcus, is a Gram-negative diplococcal bacterium that is only found naturally in humans. The meningococcus is part of the normal microbiota of the human nasopharynx and is commonly carried in healthy individuals. In some cases systemic invasion occurs, which can lead to meningitis and/or septicemia. Invasive disease caused by Neisseria meningitidis is potentially devastating, with a high case fatality rate and high rates of significant sequelae among survivors after septicaemia or meningitis. Between 2006-2015 every year between 34 and 70 were the numbers of the registered invasive disease because of Neisseria meningitis, the morbidity rate was 0.2-0.7⁰⁄₀₀₀₀. Half of the diseases (50.7%) were caused by B serotype N. meningitidis, 23.2% were C serotype. In this article the authors summarise what you must do and must not do as primary care physician when suddenly meeting a young patients suspected of having meningococcus infection. ]

LAM Extra for General Practicioners

[Changes in infectology over the past two decades]

SZALKA András

[Infectious diseases and various infections are the major causes of morbidity and mortality in developing as well as in industrialised countries. Despite the advances in the past decades in our understanding of microbes, efficient treatment of diseases and preventive approaches, more than 13 million people die every year due to infectious diseases. In the past two decades, more and more new pathogens and infections diseases have been emerging and old diseases that were almost forgotten have re-emerged. There are many new diseases for which we do not have or have hardly any efficient antimicrobial drugs and no efficient vaccines. Despite an increasing frequency of multi- and panresistant microbes, the development of new antibiotics to be used against these infections is unlikely to occur in the near future. The big pharmaceutical companies have stopped the research of antibiotics. In this situation, the only option we have is to use antibiotics rationally and to take prevention and control of infections seriously, both in the outpatient system and in hospitals. Preserving the effectiveness of currently used antibiotics is in everyone’s interest and is everyone’s responsibility]

Lege Artis Medicinae

[Principles of antibiotic use in clinical practice]

SZALKA András

[There has been a very significant reduction in morbidity and mortality associated with the use of antibiotics since they were first introduced, but, there has also been a concomitant rise in resistance among pathogens over the past 50 years. Moreover, antibiotics are sometimes associated with adverse events and their use can account for a significant proportion of the cost of treatment of some conditions. To ensure the optimal use of antibiotics doctors should use the most appropriate antibiotics to stop the spread of infection. In choosing the appropriate antimicrobial agent for the therapy of a certain infection several key factors must be considered: the most likely identity of the infecting organism, the potential antimicrobial susceptibility of the infecting organism and the host factors that influence the response to therapy. This publication is designed to introduce the concept of appropriate antibiotic therapy and how it can minimise the emergence of antimicrobial resistance while ensuring optimal patient management.]

Lege Artis Medicinae

[DIARRHOEA AND PSEUDOMEMBRANOUS COLITIS ASSOCIATED WITH ANTIBIOTIC TREATMENT]

LAKATOS László, LAKATOS Péter László

[Antibiotic treatment is complicated by diarrhea in 5 to 25% of the cases. Its prevalence depends on the antibiotic used, the patient’s age, the concomittant diseases and the immune response. The severity of the diarrhoea is variable ranging from a mild self-limiting disease lasting for 1 or 2 days to a severe condition with high mortality. The diarrhea may result from a direct effect on the gut, but more commonly it is the consequence of changes in resident gut flora. Clostridium difficile is responsible for 10 to 20% of all antibiotic-associated diarrhea cases. The clinical presentation varies from asymptomatic carriage to fulminant pseudomembranous colitis. This latter typically develops as a nosocomial infection, mainly in patients treated with cephalosporins, amoxicillin-clavulanic acid combination or clindamycin. Risk factors are advanced age, severe underlying disease, treatment in an intensive care unit, long hospitalization and invasive medical procedures. The clinical picture is characterized by frequent, watery (occasionally bloody) diarrhea, abdominal pain, tenesmus, fever, weakness. Fulminant colitis develops in 3-5% of cases. The diagnosis is based on testing for C. difficile toxins, but in selected cases rapid diagnosis can be made by flexible sigmoidoscopy. The treatment consists of the withdrawal of the implicated antibiotic along with administration of oral metronidazole or vancomycin which target C. difficile itself. Most patients respond to this treatment; however, the mortality of fulminant cases or those with severe underlying disease is high. Fifteen to 20% of the patients relapse and management of the recurrent cases is difficult. Combination treatment, probiotics and/or passive immunization may be used. Preventive measures include judicious use of antibiotics and aggressive control of the spread of C. difficile infection.]