PMID- 10714971
OWN - NLM
STAT- MEDLINE
DCOM- 20000417
LR  - 20190222
IS  - 1079-2082 (Print)
IS  - 1079-2082 (Linking)
VI  - 57
IP  - 4
DP  - 2000 Feb 15
TI  - Cost-effectiveness analysis of six strategies for cardiovascular surgery 
      prophylaxis in patients labeled penicillin allergic.
PG  - 339-45
AB  - The cost-effectiveness of different approaches to antimicrobial prophylaxis for 
      cardiovascular surgery patients labeled penicillin allergic was studied. A 
      decision-analytic model was used to examine the cost-effectiveness of six 
      strategies for antimicrobial prophylaxis in cardiovascular surgery patients at a 
      tertiary care hospital. The strategies consisted of (1) giving vancomycin to all 
      patients labeled penicillin allergic, (2) giving cefazolin to all patients 
      labeled penicillin allergic, (3) giving vancomycin to all patients with a history 
      suggesting an immunoglobulin E (IgE)-mediated reaction to penicillin and 
      cefazolin to patients without such a history, (4) administering a penicillin skin 
      test to patients with a history suggesting an IgE-mediated reaction to penicillin 
      and giving vancomycin to patients with positive results and cefazolin to all 
      others, (5) skin testing all patients labeled penicillin allergic and giving 
      vancomycin to those with positive results and cefazolin to those with negative 
      results, regardless of history, and (6) skin testing all patients and giving 
      vancomycin to those with positive results or a history suggesting an IgE-mediated 
      reaction to penicillin and cefazolin to all others. Giving cefazolin to all 
      patients labeled penicillin allergic was the least expensive strategy but was 
      associated with the highest rate of both anaphylactic and non-life-threatening 
      serious reactions. Selective use of vancomycin in patients with a history 
      suggesting an IgE-mediated reaction to penicillin was associated with an added 
      cost and a slightly lower rate of anaphylaxis. Although skin-testing strategies 
      may decrease both non-life-threatening and anaphylactic reactions, the 
      incremental cost was high. When vancomycin was given to all patients labeled 
      penicillin allergic, the incremental cost was very high. A decision-analytic 
      model indicated that selective use of vancomycin is more cost-effective than 
      indiscriminate use of vancomycin for surgical prophylaxis in cardiovascular 
      surgery patients labeled penicillin allergic.
FAU - Phillips, E
AU  - Phillips E
AD  - Division of Clinical Pharmacology, Sunnybrook & Women's College Health Sciences 
      Centre, Toronto, Ontario, Canada. elizabeth.phillips@swchsc.on.ca
FAU - Louie, M
AU  - Louie M
FAU - Knowles, S R
AU  - Knowles SR
FAU - Simor, A E
AU  - Simor AE
FAU - Oh, P I
AU  - Oh PI
LA  - eng
PT  - Journal Article
PL  - England
TA  - Am J Health Syst Pharm
JT  - American journal of health-system pharmacy : AJHP : official journal of the 
      American Society of Health-System Pharmacists
JID - 9503023
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Cephalosporins)
RN  - 0 (Penicillins)
RN  - 37341-29-0 (Immunoglobulin E)
RN  - 6Q205EH1VU (Vancomycin)
RN  - IHS69L0Y4T (Cefazolin)
SB  - IM
MH  - Anti-Bacterial Agents/economics/therapeutic use
MH  - Antibiotic Prophylaxis/*economics/*methods
MH  - *Cardiovascular Surgical Procedures
MH  - Cefazolin/economics/therapeutic use
MH  - Cephalosporins/economics/therapeutic use
MH  - Cost-Benefit Analysis
MH  - Decision Trees
MH  - Drug Hypersensitivity/*etiology
MH  - Humans
MH  - Immunoglobulin E/immunology
MH  - Penicillins/*adverse effects
MH  - Skin Tests
MH  - Vancomycin/economics/therapeutic use
MH  - Vancomycin Resistance
EDAT- 2000/03/14 09:00
MHDA- 2000/04/25 09:00
CRDT- 2000/03/14 09:00
PHST- 2000/03/14 09:00 [pubmed]
PHST- 2000/04/25 09:00 [medline]
PHST- 2000/03/14 09:00 [entrez]
AID - 10.1093/ajhp/57.4.339 [doi]
PST - ppublish
SO  - Am J Health Syst Pharm. 2000 Feb 15;57(4):339-45. doi: 10.1093/ajhp/57.4.339.