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Koh SWC, Ng TSM, Loh VWK, Goh JC, Low SH, Tan WZ, Wong HC, Durai P, Sun LJ, Young D, Tambyah PA. Antibiotic treatment failure of uncomplicated urinary tract infections in primary care. Antimicrob Resist Infect Control 2023; 12:73. [PMID: 37528415 PMCID: PMC10394943 DOI: 10.1186/s13756-023-01282-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/27/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Higher resistance rates of > 20% have been noted in Enterobacteriaceae urinary isolates towards ciprofloxacin and co-trimoxazole (C + C) in Singapore, compared with amoxicillin-clavulanate and nitrofurantoin (AC + N). This study examined if treatment failure varied between different antibiotics, given different resistant rates, for uncomplicated urinary tract infections (UTIs) managed in primary care. We also aimed to identify gaps for improvement in diagnosis, investigations, and management. METHODS A retrospective cohort study was conducted from 2019 to 2021 on female patients aged 18-50 with uncomplicated UTIs at 6 primary care clinics in Singapore. ORENUC classification was used to exclude complicated UTIs. Patients with uncomplicated UTIs empirically treated with amoxicillin-clavulanate, nitrofurantoin, ciprofloxacin or co-trimoxazole were followed-up for 28 days. Treatment failure was defined as re-attendance for symptoms and antibiotic re-prescription, or hospitalisation for UTI complications. After 2:1 propensity score matching in each group, modified Poisson regression and Cox proportional hazard regression accounting for matched data were used to determine risk and time to treatment failure. RESULTS 3194 of 4253 (75.1%) UTIs seen were uncomplicated, of which only 26% were diagnosed clinically. Urine cultures were conducted for 1094 (34.3%) uncomplicated UTIs, of which only 410 (37.5%) had bacterial growth. The most common organism found to cause uncomplicated UTIs was Escherichia coli (64.6%), with 92.6% and 99.4% of isolates sensitive to amoxicillin-clavulanate and nitrofurantoin respectively. Treatment failure occurred in 146 patients (4.57%). Among 1894 patients treated with AC + N matched to 947 patients treated with C + C, patients treated with C + C were 50% more likely to fail treatment (RR 1.49, 95% CI 1.10-2.01), with significantly higher risk of experiencing shorter time to failure (HR 1.61, 95% CI 1.12-2.33), compared to patients treated with AC + N. CONCLUSION Treatment failure rate was lower for antibiotics with lower reported resistance rates (AC + N). We recommend treating uncomplicated UTIs in Singapore with amoxicillin-clavulanate or nitrofurantoin, based on current local antibiograms. Diagnosis, investigations and management of UTIs remained sub-optimal. Future studies should be based on updating antibiograms, highlighting its importance in guideline development.
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Affiliation(s)
- Sky Wei Chee Koh
- National University Polyclinics, National University Health System, Singapore, Singapore.
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Tracy Si Min Ng
- Department of Family Medicine, National University Health System, Singapore, Singapore
- Emergency Department, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Victor Weng Keong Loh
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Family Medicine, National University Health System, Singapore, Singapore
| | - Jun Cong Goh
- National University Polyclinics, National University Health System, Singapore, Singapore
| | - Si Hui Low
- National University Polyclinics, National University Health System, Singapore, Singapore
| | - Wei Zhi Tan
- National University Polyclinics, National University Health System, Singapore, Singapore
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Hung Chew Wong
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Pradeep Durai
- Division of Urology, Department of General Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Louisa Jin Sun
- Infectious Diseases, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Doris Young
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Paul Anantharajah Tambyah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Infectious Disease, University Medicine Cluster, National University Hospital, Singapore, Singapore
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Cotia A, Oliveira Junior HA, Matuoka JY, Boszczowski Í. Clinical Equivalence between Generic Versus Branded Antibiotics: Systematic Review and Meta-Analysis. Antibiotics (Basel) 2023; 12:antibiotics12050935. [PMID: 37237838 DOI: 10.3390/antibiotics12050935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/05/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Regulatory authorities authorize the clinical use of generic drugs (GD) based on bioequivalence studies, which consist of the evaluation of pharmacokinetics after a single dose in vitro or in healthy individuals. There are few data on clinical equivalence between generic and branded antibiotics. Our aim was to synthesize and analyze the available evidence on the clinical efficacy and safety of generic antibiotics compared to their original formulations. A systematic review was performed on Medline (PubMed) and Embase and validated through Epistemonikos and Google Scholar. The last search was conducted on 30 June 2022. Meta-analyses of clinical cure and mortality outcomes were performed. One randomized clinical trial (RCT) and 10 non-randomized intervention studies were included. No differences in clinical cure were observed between groups in the meta-analysis (OR = 0.89, 95% CI [0.61-1.28]; I2 = 70%, p = 0.005). No difference was observed between groups when considering the use of carbapenems for overall mortality (OR = 0.99, 95% CI [0.63-1.55]; I2 = 78%) or death associated with infections (OR = 0.79, 95% CI [0.48-1.29], I2 = 67%). Most of the studies were observational, and the duration of follow-up, the characteristics of the participants, and the sites of infections were heterogeneous. Due to the uncertainty of the evidence, it is not possible to contraindicate the use of generics, which is an important strategy to expand access.
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Affiliation(s)
- André Cotia
- MBA Program in Prevention of Healthcare Acquired Infections, Infectious Diseases Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | | | - Jessica Y Matuoka
- Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz, São Paulo 01323-903, Brazil
| | - Ícaro Boszczowski
- Infection Control Department, Hospital Alemão Oswaldo Cruz, São Paulo 01323-020, Brazil
- Infection Control Department, Central Institute, Clinics Hospital, Medicine Faculty, Universidade de São Paulo, São Paulo 05403-010, Brazil
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Al Zoubi S, Gharaibeh L, Al-Masri B, Alsahele AB, AL-Masaeid B. Generic switching: Do future physicians in Jordan have enough knowledge and a positive attitude? Front Pharmacol 2022; 13:1037112. [PMID: 36561340 PMCID: PMC9763699 DOI: 10.3389/fphar.2022.1037112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Generic switching is a policy that has shown success in minimising pharmaceutical costs. It has also been used to mitigate recurrent and sudden drug shortages. Not all countries have policies that allow pharmacists to switch to generic drugs independently. In Jordan, only pharmacists at Ministry of Health hospitals automatically switch to generics if doctors had not already done INN prescribing. Objectives: This study targeted medical students to assess their experience with generic switching as patients, their knowledge of the subject as students, and their attitude towards it as future prescribers and policymakers. Methods: This is a descriptive, cross-sectional study conducted online. Eligibility criteria were being a fourth, fifth, or sixth-year medical school student enrolled at any of the six Jordanian universities. The questionnaire was developed by the researchers after a careful review of the relevant literature. Results: Three hundred and ninety students responded to the online questionnaire. Most participants were females (244, 62.6%), senior students in their final (6th) year (162, 41.5%) and with very good academic achievement (166, 42.6%). The highest knowledge scores concerned patient rights (0.73/1.00), followed by knowledge about monitoring after generic switching (0.66/1.00), and patients with known drug allergies (0.66/1.00). Almost half of the participants believe that pharmacists should not be given the right to do generic switching and only 16% stated that they would choose generic drugs if they needed treatment in the future. Multivariate linear regression analysis showed that significant predictors of knowledge were gender, GPA, and family income. No correlations were found between participants' knowledge scores and their attitudes towards giving pharmacists the right to independently switch drugs, or whether they would accept a substitute from pharmacists rather than having to refer to the physician. Conclusion: Medical students in Jordan lack sufficient knowledge about generic switching. Students need to be more aware of the current policies and regulations of this practice, and the role of each healthcare worker involved in it. They also need to have a more positive attitude toward generic drugs and generic switching practice to facilitate its future implementation.
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Affiliation(s)
- Sura Al Zoubi
- Department of Basic Medical Sciences, School of Medicine, Al-Balqa Applied University, As-Salt, Jordan
| | - Lobna Gharaibeh
- Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Batool Al-Masri
- School of Medicine, Al-Balqa Applied University, As-Salt, Jordan
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Meyer JC, MacBride-Stewart S, Fadare JO, Abdulrahman Jairoun A, Haque M, Massele A, Kumar S, Sefah IA, P Skosana P, Godman B. Key Considerations From a Health Authority Perspective When Proton Pump Inhibitors Are Used to Treat Gastroesophageal Reflux Disease (GERD) and Their Implications. Cureus 2022; 14:e31918. [DOI: 10.7759/cureus.31918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 11/28/2022] Open
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Bergmann F, Wulkersdorfer B, Oesterreicher Z, Bauer M, Al Jalali V, Nussbaumer-Pröll A, Wölfl-Duchek M, Jorda A, Lackner E, Reiter B, Stimpfl T, Ballarini N, König F, Zeitlinger M. Comparison of pharmacokinetics and stability of generics of cefepime, linezolid and piperacillin/tazobactam with their respective originator drugs: an intravenous bioequivalence study in healthy volunteers. J Antimicrob Chemother 2022; 77:3086-3092. [PMID: 36039038 DOI: 10.1093/jac/dkac285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The efficacy and quality of generic antibacterial drug formulations are often questioned by both healthcare specialists and patients. Therefore, the present study investigated the interchangeability of generic drugs with their originators by comparing bioequivalence parameters and stability data of generic cefepime, linezolid and piperacillin/tazobactam with their respective originator drugs. METHODS In this open-label, randomized, crossover bioequivalence study, three groups of 12 healthy volunteers each received a single intravenous infusion of either 2 g of cefepime or 4.5 g of piperacillin/tazobactam and two generic formulations, or 600 mg of linezolid and one generic formulation. Plasma sampling was performed, with a 5 day washout period between study days. Stability was tested by storing reconstituted generic and originator products according to their own storage specifications and those of the comparator products. All concentrations were measured by LC-MS. RESULTS Similar ratios of generic/originator (90% CI) Cmax were observed for Cefepime-MIP/Maxipime [93.7 (88.4-99.4)], Cefepime Sandoz/Maxipime [95.9 (89.1-103.2)], Linezolid Kabi/Zyvoxid [104.5 (91.1-119.9)], Piperacillin Kabi/Tazobac [95.9 (90.4-101.7)], Piperacillin Aurobindo/Tazobac [99.7 (84.9-104.7)], Tazobactam Kabi/Tazobac [93.4 (87.4-99.8)] and Tazobactam Aurobindo/Tazobac [97.4 (89.7-105.8)]. Accordingly, similar ratios of AUC0-t were observed for Cefepime-MIP/Maxipime [91.1 (87.6-94.8)], Cefepime Sandoz/Maxipime [97.9 (92.5-103.5)], Linezolid Kabi/Zyvoxid [99.7 (93.3-106.6)], Piperacillin Kabi/Tazobac [92.2 (88.3-96.3)], Piperacillin Aurobindo/Tazobac [99.9 (97.0-102.8)], Tazobactam Kabi/Tazobac [91.4 (86.4-96.7)] and Tazobactam Aurobindo/Tazobac [98.8 (94.3-103.6)]. Stable and similar concentrations were measured for all contiguous substances, regardless of storage conditions. CONCLUSIONS Compared with their respective originator drugs, generic cefepime, linezolid and piperacillin/tazobactam met the predetermined bioequivalence criteria. All formulations were stable under the storage conditions of their respective comparators.
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Affiliation(s)
- Felix Bergmann
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria.,Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Beatrix Wulkersdorfer
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Zoe Oesterreicher
- Medical University of Vienna, Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Martin Bauer
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Valentin Al Jalali
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Alina Nussbaumer-Pröll
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Michael Wölfl-Duchek
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Anselm Jorda
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Edith Lackner
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Birgit Reiter
- Medical University of Vienna, Clinical Institute of Laboratory Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Thomas Stimpfl
- Medical University of Vienna, Clinical Institute of Laboratory Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Nicolas Ballarini
- Medical University of Vienna, Clinical Institute of Laboratory Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Franz König
- Medical University of Vienna, Center for Medical Statistics, Informatics, and Intelligent Systems, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Markus Zeitlinger
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Neill R, Gillespie D, Ahmed H. Variation in Antibiotic Treatment Failure Outcome Definitions in Randomised Trials and Observational Studies of Antibiotic Prescribing Strategies: A Systematic Review and Narrative Synthesis. Antibiotics (Basel) 2022; 11:antibiotics11050627. [PMID: 35625271 PMCID: PMC9137992 DOI: 10.3390/antibiotics11050627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 12/10/2022] Open
Abstract
Antibiotic treatment failure is used as an outcome in randomised trials and observational studies of antibiotic treatment strategies and may comprise different events that indicate failure to achieve a desired clinical response. However, the lack of a universally recognised definition has led to considerable variation in the types of events included. We undertook a systematic review of published studies investigating antibiotic treatment strategies for common uncomplicated infections, aiming to describe variation in terminology and components of the antibiotic treatment failure outcomes. We searched Medline, Embase, and the Cochrane Central Register of Clinical trials for English language studies published between January 2010 and January 2021. The population of interest was ambulatory patients seen in primary care or outpatient settings with respiratory tract (RTI), urinary tract (UTI), or skin and soft tissue infection (SSTI), where different antibiotic prescribing strategies were compared, and the outcome was antibiotic treatment failure. We narratively summarised key features from eligible studies and used frequencies and proportions to describe terminology, components, and time periods used to ascertain antibiotic treatment failure outcomes. Database searches identified 2967 unique records, from which 36 studies met our inclusion criteria. This included 10 randomised controlled trials and 26 observational studies, with 20 studies of RTI, 12 of UTI, 4 of SSTI, and 2 of both RTI and SSTI. We identified three key components of treatment failure definitions: prescription changes, escalation of care, and change in clinical condition. Prescription changes were most popular in studies of UTI, while changes in clinical condition were most common in RTI and SSTI studies. We found substantial variation in the definition of antibiotic treatment failure in included studies, even amongst studies of the same infection subtype and study design. Considerable further work is needed to develop a standardised definition of antibiotic treatment failure in partnership with patients, clinicians, and relevant stakeholders.
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Affiliation(s)
- Rebecca Neill
- Division of Population Medicine, Cardiff University, Cardiff CF14 4YS, UK;
| | - David Gillespie
- Centre for Trials Research, Cardiff University, Cardiff CF14 4YS, UK;
| | - Haroon Ahmed
- Division of Population Medicine, Cardiff University, Cardiff CF14 4YS, UK;
- Correspondence:
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Quynh NTN, Dat VQ. Purchase of carbapenems in Vietnam, a low- to middle-income pharmaceutical market with a high burden of antimicrobial drug resistance. WHO South East Asia J Public Health 2022; 10:12-17. [PMID: 35046152 DOI: 10.4103/who-seajph.who-seajph_76_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction Carbapenems are the last-resort antibiotics used for the treatment of multidrug-resistant bacterial infections. We reported the expenditure and prices of carbapenems in public healthcare institutions in Vietnam. Materials and Methods Data on carbapenem procurement were obtained from tender-winning bids from provincial health authorities and public hospitals from 2013 to 2018. We use the anatomical therapeutic chemical index 2019 and the defined daily doses (DDDs) to describe the purchase (in number of DDD) and the price of carbapenem (presented in US dollar per DDD). Results There are four available carbapenems in Vietnam between 2013 and 2018. Imipenem/cilastatin was the most common purchased antibiotic, accounting for 50.7% of total carbapenem consumption. The vast majority of carbapenem purchase (in DDD) was imported (79.1%). By 2018, among available carbapenems, the average price of doripenem was the highest (US $85.25/DDD), followed by meropenem (US $39.4/DDD), imipenem/cilastatin (US $36.5/DDD), and ertapenem (US $24.5 per DDD). The average carbapenem price decreased by 6.3% annually. The price of doripenem (P = -0.8518, r = 0.0313) and meropenem (P = 0.8875, r = 0.0183) had a significant correlation with the number of manufacturers in the market. The price variability and the number of manufacturers of doripenem (P = 0.8173, r = 0.047) and meropenem (P = -0.8116, r = 0.499) also had a strong positive correlation. Conclusion The price of carbapenems in the Vietnam pharmaceutical market was high. Monitoring the price and consumption of last-resort antibiotic are needed to ensure availability of antibiotics in the setting with high burden of antibiotic drug resistance.
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Affiliation(s)
- Ninh Thi Nhu Quynh
- Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam
| | - Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University; Tropical Diseases and Harm Reduction, Hanoi Medical University Hospital, Hanoi, Vietnam
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Real-World Use of Generic Meropenem: Results of an Observational Study. Antibiotics (Basel) 2021; 10:antibiotics10010062. [PMID: 33440602 PMCID: PMC7827234 DOI: 10.3390/antibiotics10010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background: To determine the therapeutic effect and tolerability of meropenem in routine clinical practice, in terms of clinical and microbiological response. Methods: A real-world, observational, descriptive, longitudinal study with daily monitoring of clinical history records was conducted on all patients who were medically prescribed meropenem during a period between October 2015 and March 2016 at a university hospital in Bucaramanga (Colombia). Results: The study evaluated 84 patients with an average age of 63.2 years, mostly older adults with multiple comorbidities, of whom 54.8% were men. A positive clinical or microbiological response was obtained in 98.8% of the patients. At the end of the treatments, significant improvements in dysthermia (0% vs. 29% at the beginning, p = 0.000), tachycardia (13% vs. 47%, p = 0.049), and leukocytosis (39% vs. 15% at the beginning, p = 0.008) were evidenced. The improvement in the indicator that combines all the Systemic Inflammatory Response Syndrome (SIRS) criteria was also significant (p = 0.000). The treatment was well tolerated, although we identified some non-serious and expected adverse reactions. Conclusions: Generic meropenem proved to be effective and well tolerated for different types of infection in routine clinical practice. The results are consistent with the findings of the clinical studies with the innovator drug.
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Lin YS, Lin MT, Cheng SH. Drug price, dosage and safety: Real-world evidence of oral hypoglycemic agents. Health Policy 2019; 123:1221-1229. [PMID: 31466805 DOI: 10.1016/j.healthpol.2019.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Drug price reduction is one of the major policies to restrain pharmaceutical expenses worldwide. This study explores whether there is a relationship between drug price and clinical quality using real-world data. METHODS Patients with newly-diagnosed type 2 diabetes receiving metformin or sulfonylureas during 2001 and 2010 were identified using the claim database of the Taiwan universal health insurance system. Propensity score matching was performed to obtain comparable subjects for analysis. Pharmaceutical products were categorized as brand-name agents (BD), highpriced generics (HP) or low-priced generics (LP). Indicators of clinical quality were defined as the dosage of cumulative oral hypoglycemic agents (OHA), exposure to other pharmacological classes of OHA, hospitalization or urgent visit for hypoglycemia or hyperglycemia, insulin utilization and diagnosis of diabetic complications within 1 year after diagnosis. RESULTS A total of 40,152 study subjects were identified. A generalized linear mix model showed that HP and BD users received similar OHA dosages with comparable clinical outcomes. By contrast, LP users had similar outcomes to BD users but received a 39% greater OHA dosage. A marginally higher risk of poor glycemic control in LP users was also observed. CONCLUSIONS Drug price is related to indicators of clinical quality. Clinicians and health authorities should monitor the utilization, effectiveness and clinical safety indicators of generic drugs, especially those with remarkably low prices.
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Affiliation(s)
- Yu-Shiuan Lin
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei City, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Min-Ting Lin
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Shou-Hsia Cheng
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwan; Population Health Research Center, National Taiwan University, Taipei City, Taiwan.
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Machado-Alba JE, Gaviria-Mendoza A, Machado-Duque ME. Results of the effectiveness of two piperacillin-tazobactam molecules in the real world. Int J Infect Dis 2018; 76:91-96. [PMID: 30244077 DOI: 10.1016/j.ijid.2018.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/03/2018] [Accepted: 09/13/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE The objective was to determine the effectiveness of two piperacillin-tazobactam molecules in terms of all-cause mortality, mortality by infection, and hospital stay. METHODS A cohort study was performed involving patients treated with piperacillin-tazobactam at a clinic in Colombia. The patients were divided into those who received the innovator piperacillin-tazobactam (from July to December 2014) and those who received the generic piperacillin-tazobactam (from January to June 2015). Socio-demographic, clinical (all-cause mortality, death by infection, days of hospitalization), microbiological, pharmacological, and comorbidity variables were evaluated. Multivariate analyses were performed. RESULTS A total of 279 patients were included: 140 treated with the innovator piperacillin-tazobactam and 139 with the generic piperacillin-tazobactam. The median age was 63 years, and 56% of the patients were male. There was no statistically significant difference in death from all causes (22.9% vs. 14.4%, p=0.069), death by infection (7.9 vs. 10.8%, p=0.399), or hospital stay (18.1±16.2 vs. 15.7±11.6 days, p=0.178) between the innovator and generic piperacillin-tazobactam, respectively. CONCLUSIONS The generic piperacillin-tazobactam was equivalent to the innovator piperacillin-tazobactam with regards to all-cause mortality, mortality by infection, hospital stay, and safety, and at a lower cost, which may be useful for decision-makers in hospitals.
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Affiliation(s)
- Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Risaralda, Colombia.
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