IDWeek 2019 News Network: Reducing Cost for CABP and Exploring New Agents

Segment Description: Thomas Lodise, PharmD, PhD, professor, Albany College of Pharmacy, provides an overview of new agents for treating CABP and discusses reducing the costs of treatment.

Interview transcript: (modified slightly for readability)

The question becomes how can we reduce the overall cost? I think that kind of is a good segue with my previous response, and I think we need to be more acutely aware when we standardize our mission practices for patients who presented to the ED with community-acquired bacterial pneumonia (CABP), with suspected or documented CABP. It should be taken into account if there's an opportunity to treat the patient briefly in the observation unit that should be preferred over a short hospital admission.

On the flip side of that is among our admitted patients, what we're finding is there's a number of studies—largely generated outside the United States—is a lot of patients with infections stay in a hospital, past infection resolution. I think a lot of times the patients start on IV antibiotic, even though their infection resolves and they're improving… I wouldn't say they're back to their baseline but they're improving, and they tend to stay in a hospital longer than probably necessary.

If one considers each day of hospitalization for a CABP patient is $2500 even a 1- or 2-day hospital stay reduction could have a substantial impact on the overall cost of care. So really, I think it's really 2-fold. Better triaging patients who present to the emergency department, admitting patients who need to be admitted, and for our admitted patients, you know, when their infections resolve and there’s an opportunity to discharge to home, to do so. And this is usually 24 hours after they have clinical stabilization and improvement in some of their symptoms.

As I mentioned before we only have a limited number of classes available for CABP. We have our β-lactams or penicillin and cephalosporins. We have our respiratory fluoroquinolones which are levofloxacin and moxifloxacin. We have macrolides which we can only use in combination, as well as doxycycline. So beyond them, we had 2 drugs recently approved. Lefamulin, which is a pleuromutilin antibiotic [that is] available both intravenous and oral, was recently indicated for the treatment of adults with CABP. Also, we have omadacycline, which is a next-generation tetracycline type antibiotic, which is indicated for both patients with acute bacterial skin and skin structure infections, as well as adults with CABP. Similar to lefamulin, omadacycline is available both intravenous and oral, but for patients with CABP, intravenous [administration] should be started because this was the practice within its clinical trials. So right now, they have no oral-only data among patients with CABP with omadacycline.