Náklady na léčbu antibiotiky na pediatrickém klinickém pracovišti

Antibiotics Treatment at a Teaching Paediatric Department - Cost Benefit Study

Antibiotics Treatment at a Teaching Paediatric Department - Cost Benefit StudyA total of 1639 children were treated at the IPVZ Paediatric Clinic at Thomayer Faculty Hospital in Prague during 1999. From this number, 301 children were treated in the intensive care unit (ICU). The total cost of the Clinic for drugs for the whole year was 2 103 924.- crowns (approx. USD 57 000.-). From this amount, the cost for antibiotics (ATB) was 27 926.- which represents 17% of overall costs for drugs. Payments for ATB were as follows: 126 656 crowns for the standard and outpatient care, and 150 270.- for the ICU. To compare the frequency of different ATB and related costs, we have elaborated a defined daily dose (DDD) for each ATB, assuming it is intended for a child with a body weight of 30 kg in the quantity corresponding to the respective recommended dosage. A total of 3029 of these doses were administered in 1999, of which 1737 were administered in standard care units and 1292 at ICU.Penicillin-based antibiotics were used in 2173 doses representing a total of 71% of all doses of ATB. Most frequently we administered: phenoxymethyl penicillin, benzathine penicillin, penamecillin, benzathine phenoxymethyl penicillin, and procaine penicillin G. Aminopenicillins protecting against beta-lactamases, primarily amoxicillin/clavulanate, represent the most expensive item. They are frequently administered because of: (i) their high efficiency against common microbes causing respiratory diseases, including invasive encapsulated Haemophilus influenzae b; (ii) the relatively high occurrence of pyelonephritis (39 case per year); (iii) the relatively favourable price per DDD (149.- crowns) while retaining high efficiency. Similar reason lead to a frequent administration of cefuroxime, which can be in addition immediately changed from parenteral to peroral dosage (switch therapy), a characteristic, which we lack in other cephalosporins of the 2nd and 3rd generation. We report excellent clinical experience with doxycycline (300 DDD per year) in pneumonia caused by atypical microorganisms in school children. At the same time, doxycycline has by far the lowest price per DDD - 8.- crowns.The microbiological situation in the community, type of disease and economic aspects were also discussed as a basis for rational treatment with ATB. We believe that this analysis bears evidence of a good ATB policy of our department, not only being cost-effective, but also preventing an increase in the microbial resistance to ATB in the future. We consider this policy responsible for our previous favourable microbiological situation with respect to nosocomial infections at ICU, where we did not face any multiresistant strains.

Key words:
antibiotics treatment, paediatric department with ICU, cost/benefit analysis, penicillin-based antibiotics