Role of antibiogram in cost-effective treatment of pneumonia

ABSTRACT

High rate of mortality in pneumonia is attributed to antibiotic resistance. Rampant use of antibiotics in empirical therapy increases pathogen resistance and also increases expenditure for patients. Newer antibiotics are more expensive than older ones. Antibiogram is a chart showing, the most appropriate antibiotic to an organism. To make antibiotic therapy, effective and affordable, antibiograms specific to hospital are necessary. The primary objective of this study was to develop and antibiogram to help physicians is selecting the most sensitive and most cost-effective antibiotics against the specific pathogens of pneumonia. The sensitivity pattern of 232 pneumonia patients, admitted to Kasturba Hospital was evaluated. The cost-effectiveness of first-choice antibiotics against pneumonia pathogens was evaluated and listed in a typical antibiogram. The most common pathogens and first choice antibiotics were Klebseilla [Amikacin n=61]; Psudomonas [Piperacillin n=43]; E.coli [Meropenem n=22]; Acinobacter [Cefoperazone-sulbactam n=20]; streptococcus [Ciprofloxacin n=19]. For Klebseilla, the alternative antibiotics suggested for the above organisms were listed based on their sensitivity pattern. Amikacin [n=61], Netilmicin [n=53], imipenem [n=51], Meropenem [n=50], Gentamycin [n=45]. Piperacillin [n=43], ceftazidime [n=40], netilmicin [n=37], gentamycin [n=36], ciprofloxacin [n=36] are recommended for Pseudomonas, cefoperazone-sulbactam [n=19], Netilmicin [n=15], Amikacin [n=15] are suggested for E. coli. Cefoperazone-sulbactam [n=20], Netilmicin [n=16], Amikacin [n=10], Co-trimoxazole [n=8], Meropenem [n=8] are recommended for Acinobacter. Ciprofloxacin [n=19], Erythromycin [n=15], Chloramphenicol [n=13], Doxycycline [n=10], Penicillin [n=10] for Streptococcus. The cost of 10 day therapy for the first line antibiotics are Amikacin Rs. 3,750; Piperacillin; Rs.3,780, Meropenem Rs. 60,000, Cefoperazone-sulbactam Rs.2,306. Ciprofloxacin Rs.252.68 for Klebseilla, Pseudomonas, Ecoli, Acinobacter and Streptococcus respectively. The cost of second line drugs Netilmicin Rs.3,850; Imipenem Rs.95,600; Gentamycin Rs.29.58; Ceftazidime Rs.21,327; Co-trimoxazole; Rs. 27; Penicillin Rs.200.63; Erythromycin Rs.150.80; Chloramphenicol Rs.3,200; Doxycycline Rs.15,40 respectively. The hospital specific antibiogram developed is beneficial to choose the best and cost effective antibiotics for pneumonia patients