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382: Cost analysis of azithromycin vs. erythromycin as latency antibiotics in pregnancies complicated by preterm premature rupture of membranes
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Poster Session II with a population that is over 70% racial/ethnic minorities. Overall indicated preterm birth at BMC occurred at a rate comparable to the national prevalence (30-35%). However, Black women experienced more indicated preterm births, primarily due to hypertension. These findings point to potential strategies to reduce preterm birth by focusing on hypertensive disease and its risk factors, especially obesity and diabetes, among Black women seeking prenatal care at urban, safety net hospitals.
CONCLUSION: The use of azithromycin substituted for erythromycin
in the traditional antibiotic regimen for latency prolongation in PPROM represents a potential for substantial cost reduction.
382 Cost analysis of azithromycin vs. erythromycin as latency antibiotics in pregnancies complicated by preterm premature rupture of membranes Matthew M. Finneran, Catalin Buhimschi The Ohio State University, Columbus, OH
OBJECTIVE: A combination of erythromycin with ampicillin and
amoxicillin for a seven-day course has been the traditional antibiotic regimen of choice in management of pregnancies complicated by PPROM. However, azithromycin is often substituted for erythromycin secondary to an increased pharmacokinetic distribution that allows for single dosing with similar efficacy. This study aims to quantify the cost savings when a single oral dose of azithromycin is substituted for erythromycin in the traditional antibiotic management of PPROM. STUDY DESIGN: This was a secondary analysis of a prospective MFMU Networks randomized controlled trial investigating the efficacy of magnesium sulfate in the prevention of cerebral palsy in preterm infants. Patients with confirmed PPROM at enrollment who received erythromycin and a penicillin class antibiotic for latency prolongation were included in the analysis. Patients were stratified by hours from PPROM to delivery. The number of expected doses each patient would have received were determined using a dosing of regimen of erythromycin 250mg IV q6hrs for 2 days followed by erythromycin 333mg PO q8hrs for 5 days. These results were compared versus a single oral dose of azithromycin 1g. The average wholesale price of each drug was provided by the inpatient hospital pharmacy and was used to calculate the expected cost of each regimen over the study population. RESULTS: There were 1066 PPROM patients. The distribution of patients from membrane rupture to delivery was 129 (12.1%), 394 (37.0%), and 542 (50.9%) at <48 hours, 3-7 days, and >7 days, respectively. The number of erythromycin IV doses that would have been administered were 8,149. The number of PO erythromycin doses were 10,921. In comparison, a one-time PO azithromycin dose would have been administered 1,066 times. The combined cost of the IV and PO erythromycin regimen was $750,495.22 vs $18,207.28 for the PO azithromycin regimen, which represents a 97.6% cost reduction when azithromycin is substituted for erythromycin.
383 Comparison of azithromycin vs. erythromycin for prolongation of latency interval in pregnancies complicated by preterm premature rupture of membranes
Matthew M. Finneran1,2, Ashley Appiagyei1, Megan Templin3, Heather Mertz1 1
Carolinas Medical Center, Charlotte, NC, 2The Ohio State University, Columbus, OH, 3Dickson Advanced Analytics, Charlotte, NC
OBJECTIVE: To assess the impact on the duration of latency to de-
livery when a single oral dose of azithromycin is substituted for erythromycin in the standard antibiotic regimen used in pregnancies complicated by preterm premature rupture of membranes (PPROM). STUDY DESIGN: A retrospective cohort study of all singleton pregnancies complicated by PPROM between 23 and 33 6/7 weeks gestation at a single large metropolitan referral center from July 2012 to June 2016. Patients prior to July 2014 received a standard antibiotic regimen of 7 days of erythromycin and ampicillin/amoxicillin. After this period, patients received a single oral dose of azithromycin 1g substituted for erythromycin in this regimen. The primary outcome was latency from PPROM to delivery. Secondary outcomes included rates of cesarean section, chorioamnionitis, Apgar scores, positive neonatal blood cultures, RDS, NEC, and neonatal death.
S230 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2017
Poster Session II with a population that is over 70% racial/ethnic minorities. Overall indicated preterm birth at BMC occurred at a rate comparable to the national prevalence (30-35%). However, Black women experienced more indicated preterm births, primarily due to hypertension. These findings point to potential strategies to reduce preterm birth by focusing on hypertensive disease and its risk factors, especially obesity and diabetes, among Black women seeking prenatal care at urban, safety net hospitals.
CONCLUSION: The use of azithromycin substituted for erythromycin
in the traditional antibiotic regimen for latency prolongation in PPROM represents a potential for substantial cost reduction.
382 Cost analysis of azithromycin vs. erythromycin as latency antibiotics in pregnancies complicated by preterm premature rupture of membranes Matthew M. Finneran, Catalin Buhimschi The Ohio State University, Columbus, OH
OBJECTIVE: A combination of erythromycin with ampicillin and
amoxicillin for a seven-day course has been the traditional antibiotic regimen of choice in management of pregnancies complicated by PPROM. However, azithromycin is often substituted for erythromycin secondary to an increased pharmacokinetic distribution that allows for single dosing with similar efficacy. This study aims to quantify the cost savings when a single oral dose of azithromycin is substituted for erythromycin in the traditional antibiotic management of PPROM. STUDY DESIGN: This was a secondary analysis of a prospective MFMU Networks randomized controlled trial investigating the efficacy of magnesium sulfate in the prevention of cerebral palsy in preterm infants. Patients with confirmed PPROM at enrollment who received erythromycin and a penicillin class antibiotic for latency prolongation were included in the analysis. Patients were stratified by hours from PPROM to delivery. The number of expected doses each patient would have received were determined using a dosing of regimen of erythromycin 250mg IV q6hrs for 2 days followed by erythromycin 333mg PO q8hrs for 5 days. These results were compared versus a single oral dose of azithromycin 1g. The average wholesale price of each drug was provided by the inpatient hospital pharmacy and was used to calculate the expected cost of each regimen over the study population. RESULTS: There were 1066 PPROM patients. The distribution of patients from membrane rupture to delivery was 129 (12.1%), 394 (37.0%), and 542 (50.9%) at <48 hours, 3-7 days, and >7 days, respectively. The number of erythromycin IV doses that would have been administered were 8,149. The number of PO erythromycin doses were 10,921. In comparison, a one-time PO azithromycin dose would have been administered 1,066 times. The combined cost of the IV and PO erythromycin regimen was $750,495.22 vs $18,207.28 for the PO azithromycin regimen, which represents a 97.6% cost reduction when azithromycin is substituted for erythromycin.
383 Comparison of azithromycin vs. erythromycin for prolongation of latency interval in pregnancies complicated by preterm premature rupture of membranes
Matthew M. Finneran1,2, Ashley Appiagyei1, Megan Templin3, Heather Mertz1 1
Carolinas Medical Center, Charlotte, NC, 2The Ohio State University, Columbus, OH, 3Dickson Advanced Analytics, Charlotte, NC
OBJECTIVE: To assess the impact on the duration of latency to de-
livery when a single oral dose of azithromycin is substituted for erythromycin in the standard antibiotic regimen used in pregnancies complicated by preterm premature rupture of membranes (PPROM). STUDY DESIGN: A retrospective cohort study of all singleton pregnancies complicated by PPROM between 23 and 33 6/7 weeks gestation at a single large metropolitan referral center from July 2012 to June 2016. Patients prior to July 2014 received a standard antibiotic regimen of 7 days of erythromycin and ampicillin/amoxicillin. After this period, patients received a single oral dose of azithromycin 1g substituted for erythromycin in this regimen. The primary outcome was latency from PPROM to delivery. Secondary outcomes included rates of cesarean section, chorioamnionitis, Apgar scores, positive neonatal blood cultures, RDS, NEC, and neonatal death.
S230 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2017