This article is more than 5 years old. Information may no longer be current.

Non-nafcillin regimens cost-effective in treatment of MSSA

SAN FRANCISCO — Cefazolin and clindamycin were each as effective yet less costly compared with nafcillin in the treatment of children with methicillin-susceptible Staphylococcus aureus, according to study results presented at ID Week 2013.

“At our institution, we have traditionally treated these patients with nafcillin,” study researcher Andrew Nuibe, MD, of the division of pediatric infectious diseases at the University of Utah School of Medicine, told Infectious Diseases in Children. “We compared the safety, efficacy and cost of treatment with nafcillin to treatment with cefazolin or clindamycin and found that the in-hospital antibiotic cost of cefazolin or clindamycin was more than three times lower compared to nafcillin, an average savings of over $150 per patient.”

Andrew Nuibe

The analysis included 86 children with MSSA osteoarticular infections and confirmed bacteremia who were admitted to the Primary Children’s Medical Center in Salt Lake City from 2008 to 2012. Seventy-five children received nafcillin and 11 received non-nafcillin regimens.

Among both treatment groups, 67% of the children underwent surgery. Forty-seven percent had echocardiograms, yet there were no confirmed cases of endocarditis.

“We found that endocarditis is extremely rare in these patients, even among those whose blood cultures don’t sterilize immediately, indicating that we can reduce the use of echocardiograms,” Nuibe said.

Researchers found no statistical differences comparing nafcillin and non-nafcillin regimens regarding length of hospital stay (6 days vs. 5 days) and median bacteremia duration (39 hours vs. 33 hours).

The overall median hospital cost was $14,500.

The median total cost of cefazolin or clindamycin regimens was $53, or $11 a day, which was significantly lower than the total median cost of $246, or $41 a day, associated with nafcillin (P<.0005).

“Because our sample size is relatively small, we continue to collect data on the safety and efficacy of using non-nafcillin regimens,” Nuibe said. “Other important opportunities include comparing the clinical and economic outcomes of different treatment strategies for patients with culture-negative osteoarticular infections, and those treated with oral vs. IV therapy at home. We also continue to need good studies that can define the optimal length of treatment.”

For more information:

Nuibe A. Abstract #421. Presented at: ID Week 2013; Oct. 2-6, 2013; San Francisco.

Disclosure: The researchers report no relevant financial disclosures.