Antibiotic utilization and cost analysis in hospitalized patients with community-acquired pneumonia.

All cases of presumptive community-acquired pneumonia (CAP) in adult patients admitted to a community/teaching hospital during the first 6 months of 1993 were reviewed. A total of 67 patients ranging in age from 20-90 years (73% > 60 years) had CAP. Fifteen (22%) patients were receiving antibiotics before admission. A typical respiratory pathogen was identified in only 18 (27%) patients. Empiric parenteral antibiotics were initiated in all but 2 patients. These agents usually included cefuroxime (42%), ampicillin/sulbactam (28%), or ceftriaxone (14%). Concomitant erythromycin (25%) or clarithromycin (17%) was used empirically in 42% of patients. Parenteral antibiotics were given for a mean of 5.2 days (median, 4 days). The mean therapy cost of these common parenteral agents ranged from $69.50 (cefuroxime, 750 mg every 8 hours) to $271 (ceftriaxone, 1 gram every 12 hours). Hospitalization ranged from 2-37 days (mean, 8.3 days; median, 6 days). A total of 50 patients were switched to oral antibiotics. Prescriptions for outpatient therapy ranged from 5-21 days (mean, 8.6 days; median, 7 days). The most common oral antibiotics included cefuroxime (33%), clarithromycin (20%), and amoxicillin/clavulanate (20%). The mean therapy cost for these drugs ranged from $85.19 (cefuroxime, 500 mg every 12 hours) to $39.24 (clarithromycin, 500 mg every 12 hours). This study found that empiric therapy with low-dose parenteral cefuroxime, with or without erythromycin, followed by outpatient clarithromycin was less costly than other common regimens used to treat CAP.