Continuous vs. intermittent infusion of cefuroxime for the treatment of community-acquired pneumonia

There is increasing interest in the clinical utility and pharmacoeconomic benefits of continuous infusion (CI) therapy with beta-lactam antibiotics because this form of therapy may be as efficacious as and less costly than intermittent infusion (II) therapy. We investigated the efficacy, pharmacokinetics, and pharmacoeconomics of CI cefuroxime therapy in adult patients with a primary diagnosis of community-acquired pneumonia (CAP) who were admitted to a 800-bed community teaching hospital. Twenty-five patients with CAP who received 750 or 1500 mg of cefuroxime per day by CI were compared with 25 patients given 750 mg of cefuroxime three times daily by II. Clinical cure or improvement at the end of the course of intravenous therapy and 30 days later occurred in 23/24 and 21/22 evaluable patients in the II and CI groups, respectively. Steady-state serum cefuroxime concentrations in CI patients were 13.25 +/- 6.29 mu g/mL. These concentrations are more than two to four times the MIC90 values of the bacterial pathogens typically associated with CAP. The mean (+/- SD) total amount of intravenous drug used (II group, 8021 +/- 3444 mg; CI group, 5953 +/- 3210 mg; P = .04) and cost of the drug, labor, and supplies (II group, $83.85 +/- $34.82; CI group, $63.64 +/- $30.95; P = .04) were less in the CI group. Duration of inpatient antimicrobial therapy and length of hospital stay tended to be shorter in the CI group, by 14.7 and 11.6 hours, respectively (P = not significant).. The duration of outpatient oral therapy was longer in the CI group (P = .05). Consequently, there was a tendency toward shorter duration of inpatient therapy and longer duration of outpatient therapy in the CI group. These data support CI cefuroxime therapy as a pharmacodynamically sound and pharmacoeconomically beneficial alternative to II therapy in the treatment of CAP. However, randomized controlled trials may be warranted to verify the equivalence of efficacy between treatment regimens.