Pharmacoeconomics modes of antibiotic therapy of uncomplicated community-acquired acute pyelonephritis in a multidisciplinary hospital

Introduction. Despite the high level of resistance of E.coli as the main causative agent of urinary tract infections, fluoroquinolones are among the most frequently used antimicrobial agents in empirical therapy of uroinfections.

Aim. Clinical and economic evaluation of the effectiveness of different antibacterial strategies of community-acquired uncomplicated acute pyelonephritis with the predicted dynamics of resistance of E.coli as the main causative agent of uroinfections.

Materials and methods. Te calculations take into account the literature data on the effectiveness and safety of the starting regime of antibacterial therapy of uncomplicated pyelonephritis with cephalosporins of the 3rd generation, fluoroquinolones, aminoglycosides and carbapenems in terms of hospital specialized medical care. Te model of «decision tree» is constructed. A list of direct and indirect costs was compiled, on the basis of which the cost of 1 case of acute uncomplicated pyelonephritis therapy for each strategy of antibacterial therapy was calculated. Te «cost-effectiveness analysis» and budget impact analysis were performed.

Results. Te cost of 1 case of therapy with acute uncomplicated pyelonephritis gentamicin was the lowest in comparison with alternative strategies (33 679,89 rubles). Cost-effectiveness analysis showed that the strategy of antibacterial therapy of acute uncomplicated pyelonephritis with gentamicin dominated alternative strategies: at lower costs, it was also more effective.

Summary. For a more accurate calculation of clinical and economic efciency of antimicrobial agents it is necessary to monitor the dynamics of the resistance level in the territory of the Russian Federation.

1. Stamm WE, Hooton TM, Johnson JR. Urinary tract infections: from pathogenesis to treatment. J Infect Dis. 1989; 159(3):400—6.

2. Mazhdrakov G., Popov N. Kiddney diseases. Sophia: 1976 (In Russ).

3. Zaicev AV, Kasyan GR, Spivak LG. Acute pyelonephritis at adults. Clinical recommendation, 2016 (In Russ). URL: http://cr.rosminzdrav.ru/schema.html?id=54#/text (data obrashcheniya 25.02.2018)

4. Fihn SD. Clinical practice. Acute uncomplicated urinary tract infection in women. N Engl J Med. 2003;349(3):259—66. DOI: 10.1056/NEJMcp030027

5. Ronald A. Te etiology of urinary tract infection: traditional and emerging pathogens. Am J Med. 2002; 113 (Suppl 1A): 14S-19S.

6. European Association of Urology. Guidelines on Urological Infections. URL: http://uroweb.org/guideline/urological-infections/2015 (data obrashcheniya 25.02.2018).

7. Perepanova TS, Kozlov RS, Rudnov VA, Sinyakova LA. Antimicrobial therapy and proflaxis kidney infections, urinary tract and male genital organs. Federal clinical recommendation. Moscow: 2015 (In Russ).

8. Rafalskiy VV, Strachunskiy LS, Krechikova OI. Rezistentnost` vozbuditelej ambulatorny`x infekcij mochevy`vodyashhix putej po danny`m mnogocentrovy`x mikrobiologicheskix issledovanij. Urology 2004;2:13—17 (In Russ).

9. Sidorenko S.V., Kolbin A.S., Shlyapnikov S.A. Pharmacoepidemiological Study of the Use of Antibacterial Agents in the Multi-Speciality Hospitals of St. Petersburg. Antibiotics and chemotherapy. 2017;62(7-8):17—22 (In Russ).

10. Arepyeva M, Kolbin A, Sidorenko S, et al. A mathematical model for predicting the development of bacterial resistance based on the relationship between the level of antimicrobial resistance and the volume of antibiotic consumption. Journal of Global Antimicrobial Resistance. 2017;8:148—156. Doi: 10.1016/j.jgar.2016.11.010.

11. Arepieva M.A., Kolbin A.S., Sidorenko S.V. Prognostic model of microbial resistance based on the relationship berween antibiotic resistance and consumption. Clinical microbiology and antimicrobial chemotherapy 2016;18(3):200—211 (In Russ).

12. Yen ZS, Davis MA, Chen SC, еt al. A cost-effectiveness analysis of treatment strategies for acute uncomplicated pyelonephritis in women. Acad Emerg Med. 2003;10(4):309—14.

13. Osnovny`e ponyatiya v ocenke medicinskix texnologij: metod. posobie. Ed by Kolbin AS, Zyryanov SK, Belousov DYu. Moscow: Publisher OCI; 2013. (In Russ).

14. Avksentyeva M.A., Gerasimov B.V., Sura M.V. Kliniko-e`konomicheskij analiz (ocenka i vy`bor medicinskix texnologij i upravleniya kachestvom medicinskoj pomoshhi). Ed by Vorobyev P.A. Moscow: Newdiamed; 2004. (In Russ).

15. Planirovanie i provedenie klinicheskix issledovanij lekarstvenny`x sredstv. Ed by Belousov YuB. Moscow: Obshhestvo klinicheskix issledovatelej; 2000 (In Russ).

16. Gold MR. Cost-effectiveness in Health and Medicine. 1996 New York: Oxford University Press. 425.

17. Walley T, Haycox А, Boland A. Pharmacoeconomics. 2004: Elsevier Health Sciences. 216.

18. Recommendations upon budget impact analysis within Free for pay medical care State program. FGBU “CEKKMP” (In Russ).

19. Burbello T.A., Babak S.V., Andreyev B.V., et al. Neblagopriyatny`e pobochny`e reakcii lekarstvenny`x sredstv (posobie dlya vrachej). Ed by Burbello A.T. St. Petersburg; 2008. (In Russ).

20. Lee S, Song DY, Cho SH, et al. Impact of extended-spectrum betalactamase on acute pyelonephritis treated with empirical cefriaxone. Microb Drug Resist. 2014;20(1):39—44. DOI: 10.1089/mdr.2013.0075

21. Suankratay C, Jutivorakool K, Jirajariyavej S. A prospective study of cefriaxone treatment in acute pyelonephritis caused by extended-spectrum beta-lactamase-producing bacteria. J Med Assoc Tai. 2008;91(8):1172—81.

22. Tomera KM, Burdmann EA, Reyna OG, et al. Ertapenem versus cefriaxone followed by appropriate oral therapy for treatment of complicated urinary tract infections in adults: results of a prospective, randomized, doubleblind multicenter study. Antimicrob Agents Chemother. 2002;46(9):2895—900.

23. Shin J, Kim J, Wie SH, et al. Fluoroquinolone resistance in uncomplicated acute pyelonephritis: epidemiology and clinical impact. Microb Drug Resist. 2012;18(2):169—75. DOI: 10.1089/mdr.2011.0139

24. Jeon JH, Kim K, Han WD, et al. Empirical use of ciprofloxacin for acute uncomplicated pyelonephritis caused by Escherichia coli in communities where the prevalence of fluoroquinolone resistance is high. Antimicrob Agents Chemother. 2012;56(6):3043—3046. DOI: 10.1128/AAC.06212-11

25. Daneman N, Lu H, Redelmeier DA. Fluoroquinolones and collagen associated severe adverse events: a longitudinal cohort study. BMJ Open. 2015;5(11):e010077. DOI: 10.1136/bmjopen-2015-010077

26. Arcieri GM, Becker N, Esposito B, et al. Safety of intravenous ciprofloxacin. A review. Am J Med. 1989;87(5A): 92S-97S.

27. Etminan M, Forooghian F, Brophy JM, et al. Oral fluoroquinolones and the risk of retinal detachment. JAMA. 2012;307(13):1414—9. DOI: 10.1001/jama.2012.383

28. Dalgic N, Sancar M, Bayraktar B, et al. Ertapenem for the treatment of urinary tract infections caused by extended-spectrum β-lactamaseproducing bacteria in children. Scand J Infect Dis. 2011;43(5):339—43. DOI: 10.3109/00365548.2011.553241

29. Park SH, Choi SM, Chang YK, et al. Te efcacy of non-carbapenem antibiotics for the treatment of community-onset acute pyelonephritis due to extended-spectrum β-lactamase-producing Escherichia coli. J Antimicrob Chemother. 2014;69(10):2848—56. DOI: 10.1093/jac/dku215

30. Wells WG, Woods GL, Jiang Q, et al. Treatment of complicated urinary tract infection in adults: combined analysis of two randomized, doubleblind, multicentre trials comparing ertapenem and cefriaxone followed by appropriate oral therapy. J Antimicrob Chemother. 2004;53 Suppl 2:ii67-74.

31. Wie SH, Kim HW, Chang UI. Use of gentamicin for women with community-acquired uncomplicated acute pyelonephritis caused by gentamicin-susceptible or -resistant Escherichia coli: 10-year experience. Microb Drug Resist. 2013;19(4):316—22. DOI: 10.1089/mdr.2012.0140

32. Nicolau DP, Freeman CD, Belliveau PP, et al. Experience with a oncedaily aminoglycoside program administered to 2,184 adult patients. Antimicrob Agents Chemother. 1995;39(3):650—5.

33. General tariff agreement. St. Peterburg, 2017. (In Russ). URL: https://spboms.ru/page/docs (data obrashcheniya 25.02.2018)

34. Gomon Yu.M., Kolbin A.S., Sidorenko S.V., et al. Economic assessment of the effectiveness and safety of the commonly practiced perioperative antibiotic prophylaxis: (based on an earlier epidemiological survey of multidisciplinary hospitals). PHARMACOECONOMICS. Modern pharmacoeconomics and pharmacoepidemiology. [FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmakoepidemiologiya]. 2017;10(2):003—011. (In Russ). DOI: 10.17749/2070-4909.2017.10.2.003-011

35. Leibovici L, Vidal L, Paul M. Aminoglycoside drugs in clinical practice: an evidence-based approach. J Antimicrob Chemother. 2009;63(2):246—51. DOI: 10.1093/jac/dkn469

36. Etminan M, Forooghian F, Brophy JM, et al. Oral fluoroquinolones and the risk of retinal detachment. JAMA. 2012;307(13):1414—9. DOI: 10.1001/jama.2012.383

37. U.S. Food and Drug Administration Information for Healthcare Professionals Black Box Warning Fluoroquinolones and Tendinitis and Tendon Rupture. URL: https://www.fda.gov/Drugs/DrugSafety/ucm511530.htm (data obrashcheniya 25.02.2018).