Cost effectiveness of teicoplanin and ceftriaxone: a once-daily antibiotic regimen.

There is a high incidence of staphylococcal infection in febrile neutropenic children with a central venous line. These patients are usually initially treated with empiric antimicrobial therapy that provides broad spectrum coverage. In a study evaluating a conventional regimen of vancomycin 40 mg/kg/d plus ceftazidime 100 mg/kg/d given in three divided doses to 41 febrile children with leukemia or lymphoma, the response rate was 87% after a mean treatment duration of 16 days. A once-daily regimen of an investigational antibiotic, teicoplanin, 10 mg/kg/d and ceftriaxone 50 mg/kg/d evaluated in 47 febrile children with leukemia was found to produce an equivalent rate of success and require the same mean duration of therapy. A cost-effectiveness analysis comparing the economic impact of replacing the conventional regimen with once-daily teicoplanin-ceftriaxone revealed that a 16-day course of the latter treatment would produce cost savings in terms of the cost of the antibiotics and other nonreusable materials, as well as in nursing time. Using French drug pricing data, the savings calculated for drugs and materials were 478 FF ($80 US). The teicoplanin-ceftriaxone regimen saved approximately 14 hours in nursing time per patient. Extrapolations based on estimates of hospital occupancy and the ratio of days a patient receives antibiotic therapy to the total duration of hospital stay suggest that an average hospital ward could achieve monthly costsavings of 7,641 FF ($1,273 US) for antibiotics and materials.

The child conceived to give life. The point of view of the hematologist.

The different modalities of stem cell transplantation and the indication of each of them are briefly discussed. Transplantation can be successfully applied in hematologic diseases or in congenital disorders.

Prophylaxis, cost and effectiveness of therapy of infections caused by gram-positive organisms in neutropenic children.

Gram-positive infections are being reported with increasing frequency in children with haematological malignancies. Staphylococcus epidermidis, once considered a non-pathogenic skin contaminant, is emerging as a major cause of severe infection. However, in infants Gram-negative septicaemias are more frequent than in older children. A teicoplanin and ceftriaxone combination was assessed for use as empirical therapy of febrile episodes in neutropenic children with acute leukaemias. Of 47 patients, fever was of unknown origin in 21, and documented in 26 with 28 strains isolated; 19 Gram-positive (all sensitive to teicoplanin) and nine Gram-negative. Within 48 h, 41 patients became afebrile and the pathogen was cleared if initially present. Mean duration of treatment was 16 days. Febrile relapse occurred in 24 patients with eight documented superinfections. The need for prophylactic cover against Gram-positive organisms at the time of intravenous catheter insertion is questionable. We studied 71 patients who were randomly allocated to receive teicoplanin when the central line was inserted and if febrile, with added ceftriaxone and amikacin (arm A) or the tri-antibiotic regimen when fever occurred (arm B). In arm A a febrile episode occurred after ten days in 34/35 patients with only one Gram-positive organism isolated. In arm B a febrile episode occurred in all 36 patients after five days and ten Gram-positive strains were isolated. Those patients in arm A also received fluconazole. Amphotericin B was administered in cases of failure or relapses in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)