Oral ciprofloxacin: a pharmacoeconomic evaluation of its use in the treatment of serious infections.

The broad spectrum of antibacterial activity and favourable pharmacokinetic profile of ciprofloxacin permit oral treatment of many serious infections which have traditionally necessitated parenteral antibacterial therapy. This has been demonstrated in comparative studies, in which ciprofloxacin was as effective and well tolerated as standard parenteral therapies (usually aminoglycoside/beta-lactam combinations or broad spectrum cephalosporins) in small numbers of patients with infections of the lower respiratory tract, urinary tract, skin and soft tissue, and bones and joints. Oral ciprofloxacin is considerably less expensive than most parenteral therapies, does not necessitate therapeutic drug monitoring and can be administered on an outpatient basis. In addition, administration by the oral route is more comfortable and convenient for the patient. Pharmacoeconomic studies have confirmed that substitution of oral ciprofloxacin for parenteral therapy in the treatment of serious infections can achieve considerable savings in drug acquisition costs, and labour and supplies associated with parenteral drug administration, and may allow early discharge from hospital, resulting in even greater savings. Mean reductions of 43 to 83% were achieved in antibacterial costs in 3 randomised prospective studies, when patients received oral ciprofloxacin instead of various parenteral agents, from the beginning of treatment, or after 3 days' parenteral therapy. It can be concluded that oral ciprofloxacin offers considerable scope for cost avoidance when appropriately substituted for parenteral therapy in the treatment of serious infections.