Imipenem/cilastatin versus gentamicin/clindamycin: a cost effectiveness study

A previously published clinical trial was used for analysis of costs for antibiotic treatment in patients with serious bacterial infections requiring the use of injectable broad spectrum antibiotics. The patients were randomized to receive imipenem/cilastatin 500/500 mg q6h (77 patients of which 56 were evaluable for efficacy) or clindamycin 600 mg q6h plus gentamicin 1.5 mg/kg with dose intervals determined by serum concentration monitoring (86 patients of which 62 were evaluable for efficacy). An analysis of the costs for antibiotics, including drugs, equipment and staff for administration and gentamicin serum concentration assays, showed that imipenem/cilastatin was not more expensive than gentamicin plus clindamycin per treatment day although the drug cost was considerably higher for imipenem/cilastatin. Since imipenem/cilastatin was significantly more effective and caused less frequent adverse reactions than gentamicin plus clindamycin it was more cost-effective in the patients studied.

Accuracy at radiography and probing for the diagnosis of proximal caries

In 63 teenagers the proximal surfaces of premolars to be extracted for orthodontic reasons and the adjacent surfaces of neighboring teeth, 598 surfaces in all, were examined radiographically and by probing. Direct inspection after extraction revealed that 51% of the surfaces had incipient carious lesions and 5% lesions with cavities. Of the surfaces with cavities 82.1% were correctly diagnosed radiographically if any radiolucency, regardless of its extent, was used as a diagnostic criterion. However, this yielded a false positive rate of 19.6%. If only radiolucencies extending at least into the inner third of the enamel were called positive the true positive rate was 36.7% and the associated false positive rate 1.6%. At a 5% cavity frequency the predictive positive values were 17% and 53%, respectively. Probing yielded a true positive rate of about 29% and a false positive rate of 1.1% with a predictive positive value of 50-57%. All radiolucencies extending into the dentin were associated with cavities. When the most liberal radiographic criterion was used 37.5% of all carious lesions, whether associated with a cavity or not, were detected and 3.8% of sound surfaces were falsely called carious. The corresponding predictive positive value at the actual rate of incipient lesions and lesions with cavities was 92.6%.