Pharmacoeconomics: Levofloxacin

Levofloxacin Pharmacoeconomics and Route of Administration

During the POS and PCP, 49 and 82 cases respectively received IV levofloxacin. No significant differences in age, gender, or infection type were observed between groups. The majority of infections during both periods were community-acquired pneumonia, followed by complicated UTIs. All patients received a 500 mg dose of levofloxacin once daily for the entire treatment duration, including those treated for complicated UTIs.

Out of the 131 patients, 30 in the POS and 53 in the PCP met conversion criteria while receiving levofloxacin treatment (p = 0.827). No significant differences in age, gender, or infection types were found between these subpopulations. Most patients eligible for conversion to oral treatment had community-acquired pneumonia.

Comparison of Treatment Periods

Patients meeting conversion criteria in both the POS and PCP periods had similar demographics. The mean day of eligibility for conversion was comparable between the two groups, although a significantly higher number of patients in the PCP were converted to oral treatment (p = 0.009). On average, PCP patients were converted to oral therapy 3.4 days earlier. Four patients in the PCP group did not have their treatment converted due to weekends or holiday interruptions, but IV levofloxacin was discontinued before the pharmacist could convert to oral therapy. The median length of stay was significantly shorter for conversion candidates in the PCP compared to the POS group (p = 0.031).

Oral Treatment Success

During the PCP, two patients required reconversion to IV therapy. Neither reconversion was due to failure of the oral regimen. One patient suffered a stroke three days post-conversion and required a feeding tube, while the second was readmitted to the ICU for non-infection-related complications. Both were subsequently switched back to IV therapy.

Of the 53 patients eligible for oral conversion, 30 were clinically evaluable. Most of these patients (60%) had community-acquired pneumonia; other conditions included six complicated UTIs, two skin infections, and individual cases of meningitis, urosepsis, MRSA, and cholangitis. The primary reason for non-evaluability was the presence of confounding factors that complicated the diagnosis. All 30 clinically evaluable patients were available for follow-up within two weeks after discontinuation of levofloxacin. The clinical success rate was 100%, with no adverse events reported in either group related to IV or oral levofloxacin treatment.

Cost Analysis

According to the 16 interventions documented by pharmacists, the average time spent identifying and converting IV levofloxacin to oral therapy was 9 minutes (range: 1–20 minutes), resulting in an additional cost of $5.10 per patient during the PCP. Nursing costs associated with administering and monitoring IV levofloxacin amounted to $0.83 per dose.

For patients who met conversion criteria, costs at all levels were significantly lower during the PCP compared to the POS. The most notable difference was in level-3 care, where savings of approximately $3,300 per patient were realized. In the intention-to-treat analysis, only level-1 costs were significantly lower for the PCP, while level-2 costs were non-significantly lower.