Extended infusion of cephalosporins, penicillins and carbapenems: a cost-effective point-of-view and critical appraisal of Surviving Sepsis Campaign guidelines

Narrative/ introduction. In the last edition of the Surviving Sepsis Campaign guidelines - SSC guidelines -   recommendations regarding the optimization of antibiotics pharmacokinetics and pharmacodynamics (PK/PD) were made. Among these, the use of extended infusion of beta-lactams (penicillins, cephalosporins and carbapenems), are proposed to improve clinical and microbiological outcomes. However, according to the authors, studies of the economic implications of extended infusion – cost-effectiveness studies – are needed for these recommendations. Caveats. Sepsis represents a huge economic burden around the world due to the need for hospital and ICU beds, qualified staff and therapies for the treatment of the pathology, whereas it is known that antibiotics are the mainstay therapy. The basic research question for cost-effectiveness studies is to understand the superiority of a new and more expensive intervention over the "standard" therapy and, then, the implications of this in a health system and time perspective. However, extended infusion of antibiotics has shown a benefit in clinical outcomes and its use can reduce direct costs since is less expensive than the standard approach, considering that smaller amounts of the antibiotic are needed to reach the same PK/PD and clinical effect. Moreover, additional costs to do an extended infusion would not be significant, and more effective therapy could also reduce the indirect economic burden on the health systems. Therefore, it is beyond the scope of cost-effectiveness analyses, and should be incorporated by health systems.