Retro-respective Evaluation of New Fixed Dose Combination of Antibiotics in Management of Severe Skin and Soft Tissue Infections – A Comparative Pharmacoeconomic Study

Study Background: Skin and soft tissue infections (SSTIs) are the second most common infection encountered in hospitals. Present study aims to comparatively analyze efficacy of new fixed dose combination (FDC) with teicoplanin in treating severe SSTI patients and to assess the costs associated with respective therapies.

Materials and Methods: During this retrospective study, case sheets of patients who were treated for severe SSTIs / Sepsis with teicoplanin or fixed dose combination of Vancomycin +Ceftriaxone+ adjuvant (FDC) between March 2009 and August 2012 at tertiary care hospitals were analyzed. Various demographic features, antibiotic therapy, length of treatment duration and the resulting efficacy were evaluated. Microbiological correlation was done with clinical success monitored in terms of complete omission of systemic signs and symptoms and evaluation of % failure in each case or need of concomitant therapy to treat sepsis. Overall cost involved in the infections management was estimated in INR.

Results: A total of 314 confirmed SSTI cases out of 538 patients who met other study entrance criteria were further analyzed. Out of these 314 patients, empirical treatment with teicoplanin was received by 186 patients and 128 patients were treated with FDC empirically. Amidst all the patients, 132 (70.96%) of 186 from teicoplanin group and 102 (79.68%) of 128 from FDC group achieved clinical success. 26 / 128 (in FDC group) and 54 /186 (in Teicoplanin group) patients whose MIC falls in intermediate range failed to respond and tigecycline was added to ongoing therapy. Comparative cost expenditure analysis of the two drug treatment groups revealed that, the overall treatment cost for patients cured with empirical teicoplanin group was 92.83% more than that of FDC therapy. The strongest predictor of the increase in treatment costs was clinical failure. Similar trends were maintained for the patients cured with tigecycline additional therapy, with teicoplanin group accounting 56.63% more expenditure than FDC group.

Conclusion: For the treatment of different types of SSTIs, the empirical intravenous FDC therapy was safe, well tolerated with higher efficacy including in infections caused by multidrug resistant strains (VRSA and GISA) than teicoplanin. Pharmacoeconomic analysis clearly shows that starting appropriate empirical antibiotic therapy has a large impact on the cost of treatment in management of SSTIs and preferring FDC empirically both as mono/combination therapy, can significantly reduce the cost involved in the treatment. Empirical use of FDC followed by correlating it with MIC values can prevent failure and SSTI turning in sepsis.