Budget Impact Analysis of Ceftriaxone Dosing Regimens for Urinary Tract Infections in a Pediatric Hospital 

Session: Poster Abstract Session: Antibiotic Stewardship: Pediatrics
Saturday, October 29, 2016
Room: Poster Hall
  • UTI Ceftriaxone Poster .pdf (239.8 kB)
  • Background: Ceftriaxone is commonly utilized due to its activity against major pediatric pathogens. While it utilizes time-dependent killing pharmacodynamics, the use of twice-daily dosing in comparison to once-daily dosing has not shown increased antibiotic efficacy but an increase in cost in specific conditions. Phoenix Children's Hospital (PCH) has placed restrictions for the utilization of twice-daily ceftriaxone dosing on several indications including ruptured appendicitis without abscess, urinary tract infections (UTIs), and community acquired pneumonia. A previous cost-savings study conducted by the PCH Antibiotic Stewardship Committee showed an estimated annual cost-savings of $219,000 from the ceftriaxone component of a ruptured appendicitis without abscess order set.

    Methods: A 24-month retrospective chart review was conducted from 1/1/2010 – 12/31/2010 and 1/1/2014 – 12/31/2014 at PCH of 100 patients. All PCH inpatients who received at least two days of ceftriaxone therapy were included in the review. Patients who received a one-time dose or received therapy for one day only were excluded. Charts were identified for review utilizing data obtained from the pharmacy order management system. The electronic medical record system was queried for ceftriaxone dosing and administration data. Dosing indication was considered appropriate if it was consistent with the Pediatric and Neonatal Dosage Handbook, 22nd edition.

    Results: When comparing the savings related to cost of drug and to cost of administration of an extra dose of ceftriaxone per day for the treatment of UTI, the application of a single daily dose regimen lead to a cost saving of $56,000 when comparing the two periods studied.

    Conclusion: In addition to a previously estimated annual cost savings of $219,000 with the ceftriaxone component of a ruptured appendicitis order set, the decrease in twice-daily dosing for UTIs has a potential to save an additional $56,000 for a total annual cost savings of approximately $275,000 for these two indications alone. Significant cost savings margins may be realized by upholding the current restrictions of twice-daily dosing to meningitis, line infections, and as directed by the ID specialists.

    Wassim Ballan, MD1, Cynthia Toy, PharmD2, Richard Engel, MD1 and Millie Wisdom, PharmD1, (1)Phoenix Children's Hospital, Phoenix, AZ, (2)St Joseph's Hospital, Phoenix, AZ


    W. Ballan, None

    C. Toy, None

    R. Engel, None

    M. Wisdom, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.