Advertisement

Pharmacy World and Science

, Volume 19, Issue 3, pp 133–141 | Cite as

The treatment of staphylococcal infections with special reference to pharmacokinetic, pharmacodynamic and pharmacoeconomic considerations

  • R Janknegt
Article

Abstract

The choice of antibiotics for the treatment of staphylococcal infections depends to a high degree on the susceptibility patterns in the hospital in question. These may be highly variable and considerable differences between countries and hospitals exist. The insight into the pharmacodynamic aspects of antimicrobial agents has increased considerably in the last 5 years, resulting in new treatments, such as once daily administration of aminoglycosides and continuous infusion of betalactam antibiotics. The antibiotic policy in Dutch hospitals for the treatment of staphylococcal infections is discussed. In most Western countries with a relatively low incidence of MRSA, penicillin–derivatives, such as flucloxacillin (or cloxacillin, methicillin and nafcillin) will be the drug of choice, because of their good in-vitro activity, low toxicity, good clinical efficacy and relatively low cost. If the incidence of MRSA increases, drugs such as the glycopeptides will be of more importance. This will of course have a clear economic impact, as both vancomycin and teicoplanin are considerably more expensive than agents such as flucloxacillin and oral treatment is not possible. Pharmacoeconomic aspects also play a role. As a rule, intravenous antimicrobial agents are considerably more expensive than the oral formulations. Before oral administration can be recommended, a reliable oral absorption, also in seriously ill patients, must have been demonstrated. Other aspects that influence the cost of therapy are hospital stay and the possibility of outpatient treatment.

Staphylococcal infections Antibiotics Drug choice Resistance Pharmacoeconomics 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Rupp ME, Archer GL. Coagulase-negative staphylococci: pathogens associated with medical progress. Clin Infect Dis 1994;19:231-45.Google Scholar
  2. 2.
    Turnidge J, Grayson ML. Optimum treatment of staphylococcal infections. Drugs 1993;45:353-66.Google Scholar
  3. 3.
    Jewell M. Perspective on professor Aikawa's paper. In: Davey PG ed. Resistance in Gram-positive bacteria. Implications for the economics of treatment. The Medicine Publishing Foundation, Oxford: 1994,11-6.Google Scholar
  4. 4.
    Voss A, Milatovic D, Wallrauch-Schwarz C, Rosdahl VT, Braveny I. Methicillin-resistant S.aureus in Europe. Eur J Clin Microbiol Infect Dis 1994;13:50-5.Google Scholar
  5. 5.
    Boyce JM. Methicillin-resistant S.aureus: a continuing infection control challenge. Eur J Clin Microbiol Infect Dis 1994;13:45-9.Google Scholar
  6. 6.
    Aikawa N. The incidence of MRSA in Japan. In: Davey PG ed. Resistance in Gram-positive bacteria. Implications for the economics of treatment. The Medicine Publishing Foundation, Oxford, 1994,1-10.Google Scholar
  7. 7.
    Gyssens IC, Lennards CA, Hekster YA, van der Meer JWM. Cost of hospital antimicrobial chemotherapy. A method for global cost estimation. Pharm Weekbl Sci 1991;13:248-52.Google Scholar
  8. 8.
    Janknegt R. Antimicrobial Agents. Disease and pharmacokinetics. Reed Elsevier, Amsterdam, the Netherlands 1994.Google Scholar
  9. 9.
    Schmidt JP, Regamey C. Anstoss zu verkurzter i.v. Antibiotikabehandlung als kostensparende Intervention bei der Behandlung unkomplizierter Infekte. Schweiz Med Wochenschr 1994;124:2229-33.Google Scholar
  10. 10.
    Janknegt R, Boogaard-van den Born J, Hameleers BAMJ, Hooymans PM, Rang J, Smits CAM, Willems-Thissen ME. Pharmacokinetics of amoxycillin in elderly in-patients. Pharm WeekbL Sci 1992;14:27-29.Google Scholar
  11. 11.
    Craig WA, Leggett J, Totsuka K, Vogelman B. Key pharmacokinetic parameters of antibiotic efficacy in experimental ani-mal infections. J Drug Devel 1988;1 suppl 3:7-15.Google Scholar
  12. 12.
    Roosendaal R, Bakker-Woudenberg IAJM, van den Berg JC, Michel, MF. Therapeutic efficacy of continuous versus intermitten administration of ceftazidime in an experimental Klebsiella pneumoniae pneumonia in rats. J Infect Dis 1985;152:373-8.Google Scholar
  13. 13.
    Janknegt R, van der Meer. Sequential therapy with iv and oral cephalosporins. J Antimicrob Chemother 1994;33:169-77.Google Scholar
  14. 14.
    LeBel M, Spino M. Pulse dosing versus continuous infusion of antibiotics. Pharmacokinetic-pharmacodynamic considerations. Clin Pharmacokinet 1988;14:71-85.Google Scholar
  15. 15.
    Craig WA, Ebert SC. Continuous infusion of betalactam antibiotics. Antimicrob Agents Chemother 1992;36:2577-83.Google Scholar
  16. 16.
    Voorn GP, Thompson J, Goessens WHF, Schmal-Bauer WC, Broeders PHM, Michel MF. Paradoxical dose effect of continuously administered cloxacillin in treatment of tolerant S.aureus endocarditis in rats. J Antimicrob Chemother 1994;33:585-93.Google Scholar
  17. 17.
    Janknegt R, Stobberingh E, Wijnands WJA. Antibioticabeleid in nederlandse ziekenhuizen. II Gebruiksgegevens. Ziekenhuisfarmacie 1992;8:96-101.Google Scholar
  18. 18.
    Janknegt R, Stobberingh EE, Wijnands WJA. Antimicrobial drug utilisation in the Netherlands, Germany and Belgium. Eur J Clin Microbiol Infect Dis 1993;12:832-38.Google Scholar
  19. 19.
    Raad I. I., Sabbagh M. F. Optimal duration of therapy for catheter-related S.aureus bacteremia: a study of 55 cases and review. Clin Infect Dis 1992;14:75-82.Google Scholar
  20. 20.
    Janknegt R. Macrolide antibiotica. Overzicht van bacteriologie en farmacokinetiek. J Drug Res 1987;12:229-35.Google Scholar
  21. 21.
    Periti P, Mazzei T, Mini E, Novelli A. Clinical pharmacokinetic properties of the macrolide antibiotics. Clin Pharmacokinet 1989;16:264-82.Google Scholar
  22. 22.
    Periti P, Mazzei M, Mini E, Novelli A. Pharmacokinetic drug interactions of macrolides. Clin Pharmacokinet 1992;23:106-31.Google Scholar
  23. 23.
    Janknegt R. Teicoplanin in perspective. A critical comparison with vancomycin. Pharm Weekbl Sci 1991;13:153-60.Google Scholar
  24. 24.
    Horton MW, Deeter RG, Sherman RA. Treatment of peritonitis in patients undergoing contnuous ambulatory peritoneal dialysis. Clin Pharm 1990;9:102-18.Google Scholar
  25. 25.
    O'Brien MA, Mason NA. Systemic absorption of intraperitoneal antimicrobials in continuous ambulatory peritoneal dialysis. Clin Pharm 1992;11:246-54.Google Scholar
  26. 26.
    Hyatt JM, McKinnon PS, Zimmer GS, Schentag JJ. The importance of pharmacokinetic/pharmacodynamic surrogate markers to outcome. Clin Pharmacokinet 1995;28:143-60.Google Scholar
  27. 27.
    Garrelts JC, Horst WD, Silkey B, Gagnon S. A pharmacoeconomic model to evaluate antibiotic costs. Pharmacother 1994;14:438-45.Google Scholar
  28. 28.
    Hackbarth CJ, Chambers HF. Methicillin-resistant staphylococci: detection methods and treatment of infections. Antimicrob Agents Chemother 1989;33:995-99.Google Scholar
  29. 29.
    Neu HC. Issues in Gram-positive infections: the present and the future. J Antimicrob Chemother 1988;21 supplement C:167-69.Google Scholar
  30. 30.
    Vandenbroucke-Grauls CM, Frenay HME, van Klingeren B, Savelkoul TF, Verhoef J. Control of epidemic methicillin-resistant Staphylococcus aureus in a Dutch university hospital. Eur J Clin Microbiol Infect Dis 1991;10:6-11.Google Scholar
  31. 31.
    Hoban D, Jones RN. The North American component of an international MIC trial monitoring ofloxacin resistance. Drugs 1993;45 suppl. 3:167-69.Google Scholar
  32. 32.
    Watanabe Y, Ebert S, Graig W. The AUC/MIC ratio is a unifying parameter for comparison of in-vivo activity among fluorquinolones. 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy 1992: abstract 42.Google Scholar
  33. 33.
    Forrest A, Nix DE, Bellow CH, Goss TF, Birmingham MC, Schentag JJ. Pharmacodynamics of intravenous ciprofloxacin in seriously ill patients. Antimicrob Agents Chemother 1992;37:1073-81.Google Scholar
  34. 34.
    Janknegt R. Fluoroquinolones. Use of clinical data to aid formulary choice by the System of Objective Judgement Analysis (SOJA) Method. Pharmacoeconomics 1994;6:15-33.Google Scholar
  35. 35.
    D'Espine M, Bellido F, Auckenthaler R, Lew D, Leemann T, Pechere JC, Hirschel B. Serum levels of ciprofloxacin in septicemic patients. Is oral administration safe? International Congress on Infectious Diseases 1988, Rio de Janeiro; abstract 528.Google Scholar
  36. 36.
    Ketterl R, Beckurts T, Suuebinger B, Claudi B. Use of ofloxacin in open fractures and in the treatment of post-traumatic osteomyelitis. J Antimicrob Chemother 1988;22 supplement C:159-66.Google Scholar
  37. 37.
    Thys JP, Jacobs F, Bijl B. Role of quinolones in the treatment of bronchopulmonary infections, particularly pneumocococcal and community-acquired penumonia. Eur J Clin Microb Infect Dis 1991;10:304-15.Google Scholar
  38. 38.
    Tripodi MF, Attanasio V, Adinolfi LE, Floriuo A, Cione P, Cuccurullo S, Utili R, Ruggiero G. Prevalence of antibiotic resistance among clinical isolates of methicillin-resistant staphylococci. Eur J Clin Microbiol Infect Dis 1994;13:148-52.Google Scholar
  39. 39.
    Munckhof WJ, Grayson ML, Turnidge JD. A meta-analysis of studies on the safety and efficacy of aminoglycosides given either once daily or as divided doses. J Antimicrob Chemother 1996;37:645-63.Google Scholar
  40. 40.
    Jewell M. Cost-containment using an outcome-based practice model for the management of MRSA. J Chemother 1004;6 suppl. 2:35-9.Google Scholar
  41. 41.
    Janknegt R, Wijnands WJA, Stobberingh EE. Antibiotic policies in Duch hospitals for the treatment of pneumonia. J Antimicrob Chemother 1994;34:431-42.Google Scholar
  42. 42.
    Janknegt R, Monkelbaan JF, Stobberingh E, Wijnands WJA. Antibiotic policy in Dutch hospitals for the treatment of patients with serious infection. J Antimicrob Chemother 1994;34:1059-69.Google Scholar
  43. 43.
    Hanatani Y. MRSA enterocolitis. J Clin Exper Med 1993;106:771-4.Google Scholar
  44. 44.
    Rodvold KA. The role of outpatient treatment for serious Gram-positive infections. In: Davey PG editor, Resistance in Gram-positive bacteria. Implications for the economics of treatment. Davey PG ed. Oxford: The Medicine Publishing Foundation, 1994, 21-7.Google Scholar
  45. 45.
    Graninger W, Wenisch C, Wiesinger E, Menschik M, Karim J, Presterl E. Experience with outpatient intravenous teicoplanin therapy for chronic osteomyelitis. Eur J Clin Microbiol Infect Dis 1995;14:643-7.Google Scholar

Copyright information

© Kluwer Academic Publishers 1997

Authors and Affiliations

  • R Janknegt
    • 1
  1. 1.Dept. of Clinical Pharmacy and Toxicology,Maasland Ziekenhuis,Sittard,the Netherlands

Personalised recommendations