Extended infusion of cephalosporins, penicillins and carbapenems: a cost-effective point-of-view and critical appraisal of Surviving Sepsis Campaign guidelines

Authors

  • Sérgio Renato da Rosa Decker Departamento de Medicina Interna, Hospital Nossa Senhora da Conceição (Porto Alegre). Rio Grande do Sul, Brasil. https://orcid.org/0000-0001-6989-3079
  • Lucas Emanuel Marzzani Departamento de Medicina Interna, Hospital Nossa Senhora da Conceição (Porto Alegre). Rio Grande do Sul, Brasil. https://orcid.org/0000-0002-4764-8571
  • Pedro Rotta de Ferreira Departamento de Medicina Interna, Hospital Nossa Senhora da Conceição (Porto Alegre). Rio Grande do Sul, Brasil. https://orcid.org/0000-0001-9119-6819

DOI:

https://doi.org/10.17267/2675-021Xevidence.2022.e4605

Keywords:

Cost Analysis, Sepsis, Antibiotics

Abstract

Narrative/ introduction. In the last edition of the Surviving Sepsis Campaign guidelines - SSC guidelines -   recommendations regarding the optimization of antibiotics pharmacokinetics and pharmacodynamics (PK/PD) were made. Among these, the use of extended infusion of beta-lactams (penicillins, cephalosporins and carbapenems), are proposed to improve clinical and microbiological outcomes. However, according to the authors, studies of the economic implications of extended infusion – cost-effectiveness studies – are needed for these recommendations.

Caveats. Sepsis represents a huge economic burden around the world due to the need for hospital and ICU beds, qualified staff and therapies for the treatment of the pathology, whereas it is known that antibiotics are the mainstay therapy. The basic research question for cost-effectiveness studies is to understand the superiority of a new and more expensive intervention over the "standard" therapy and, then, the implications of this in a health system and time perspective. However, extended infusion of antibiotics has shown a benefit in clinical outcomes and its use can reduce direct costs since is less expensive than the standard approach, considering that smaller amounts of the antibiotic are needed to reach the same PK/PD and clinical effect. Moreover, additional costs to do an extended infusion would not be significant, and more effective therapy could also reduce the indirect economic burden on the health systems. Therefore, it is beyond the scope of cost-effectiveness analyses, and should be incorporated by health systems.

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References

(1) Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181–247. https://doi.org/10.1007/s00134-021-06506-y

(2) Roberts JA, Abdul-Aziz MH, Lipman J, Mouton JW, Vinks AA, Felton TW, et al. Individualised antibiotic dosing for patients who are critically ill: Challenges and potential solutions. Lancet Infect Dis. 2014;14(6):498–509. https://doi.org/10.1016/S1473-3099(14)70036-2

(3) Detsky AS, Naglie IG. A Clinician’s Guide to Cost-Effectiveness Analysis. Ann Intern Med. 1990;113(2):147. https://doi.org/10.7326/0003-4819-113-2-147

(4) Machado FR, Cavalcanti AB, Bozza FA, Ferreira EM, Angotti Carrara FS, Sousa JL, et al. The epidemiology of sepsis in Brazilian intensive care units (the Sepsis PREvalence Assessment Database, SPREAD): An observational study. Lancet Infect Dis. 2017;17(11):1180–9. https://doi.org/10.1016/S1473-3099(17)30322-5

(5) Silva EN, Silva MT, Pereira MG. Identificação, mensuração e valoração de custos em saúde. Epidemiol e Serv saude Rev do Sist Unico Saude do Bras. 2016;25(2):437–9. http://dx.doi.org/10.5123/S1679-49742016000200023

(6) OneHealthTrust. ResistanceMap: Antibiotic resistance [map] [Internet]. Maryland: OneHealthTrust; 2022. [cit 2022 may 31]. Available from: https://resistancemap.onehealthtrust.org/AntibioticUse.php

(7) Agência Nacional de Vigilância Sanitária – Anvisa. Câmara de Regulação do Mercado de Medicamentos – CMED. Listas de preços de medicamentos [Internet]. Available from: https://www.gov.br/anvisa/pt-br/assuntos/medicamentos/cmed/precos

(8) Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Ciência e Tecnologia. Diretrizes metodológica: Diretriz de Avaliação Econômica [Internet]. Brasília: Ministério da Saúde; 2014. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_metodologicas_diretriz_avaliacao_economica.pdf

(9) Jaruratanasirikul S, Thengyai S, Wongpoowarak W, Wattanavijitkul T, Tangkitwanitjaroen K, Sukarnjanaset W, et al. Population pharmacokinetics and Monte Carlo dosing simulations of meropenem during the early phase of severe sepsis and septic shock in critically ill patients in intensive care units. Antimicrob Agents Chemother. 2015;59(6):2995–3001. https://doi.org/10.1128/AAC.04166-14

(10) Yang H, Zhang C, Zhou Q, Wang Y, Chen L. Clinical outcomes with alternative dosing strategies for piperacillin/tazobactam: A systematic review and meta-analysis. PLoS One. 2015;10(1): e0116769. https://doi.org/10.1371/journal.pone.0116769

(11) Drusano GL. Prevention of resistance: A goal for dose selection for antimicrobial agents. Clin Infect Dis. 2003;36(1):S42-50. https://doi.org/10.1086/344653

(12) Rybak M, Lomaestro B, Rotschafer JC, Moellering R, Craig W, Billeter M, et al. Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Heal Pharm. 2009;66(1):82–98. https://doi.org/10.2146/ajhp080434

(13) Santos RP, Deutschendorf C, Carvalho OF, Timm R, Sparenberg A. Antimicrobial stewardship through telemedicine in a community hospital in southern Brazil. J Telemed Telecare. 2013;19(1):1–4. https://doi.org/10.1177/1357633X12473901

Published

11/21/2022

Issue

Section

Critical Appraisal of Evidence

How to Cite

1.
Decker SR da R, Marzzani LE, Ferreira PR de. Extended infusion of cephalosporins, penicillins and carbapenems: a cost-effective point-of-view and critical appraisal of Surviving Sepsis Campaign guidelines. Evidence [Internet]. 2022 Nov. 21 [cited 2024 Nov. 4];4:e4605. Available from: https://journals.bahiana.edu.br/index.php/evidence/article/view/4605

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