Pharmacoeconomics of prophylactic, empirical, and diagnostic-based antibiotic treatments: Focus on surgical site infection and hospitalized community-acquired pneumonia

The microbial etiology and antibiotic resistance are often omitted from reports on the clinical and economic impact of antibiotic use, despite their importance for the mid- and long-term. This thesis focuses on the pharmacoeconomic aspects of prophylactic, empirical and diagnostics-based measures in the use of the antibiotic treatment in the three illustrative cases of sepsis, surgical site infections (SSIs), and hospitalized community-acquired pneumonia (CAP). Prophylactic antibiotics are used for SSI prevention, whereas empirical antibiotics are used for the temporary initial treatment of sepsis and hospitalized CAP. Typically, often antibiotics are often given before the pathogen has been identified. The prophylactic- and empirical-antibiotic treatments are based on the pathogenic patterns of causative agents and the patterns of antibiotic sensitivity and its accuracy. High intensity of antibiotics without guided microbiological tests can generate resistant organisms, causing therapy failure in individual patients, high medical costs and major future problems. The implementation of diagnostic-based antibiotic treatments in developing countries with a high incidence of infectious diseases, such as Indonesia, can be considered a cost-effective strategy as illustrated in this thesis. Diagnostic-based antibiotic treatments using microbiological evaluations contribute to improving optimally targeted use of prophylactic and empirical antibiotics. Furthermore, the thesis supports a policy that patients who have started on empirical antimicrobial therapy and who show clinical improvement within the first three days should be switched from the intravenous to the oral form of the same antibiotic.