A systematic review and economic model of switching from non-glycopeptide to glycopeptide antibiotic prophylaxis for surgery

Cranny G, Elliott R, Weatherly H, Chambers D, Hawkins N, Myers L, Sculpher M, Eastwood A
Record ID 32008000060
English
Authors' objectives:

"Our overall objective was to determine whether there is a level of MRSA prevalence at which a switch from non-glycopeptide to glycopeptide antibiotics for routine prophylaxis is indicated in surgical environments with a high risk of MRSA infection. We addressed this question by undertaking:

1) a systematic review of the effectiveness of glycopeptide compared with non-glycopeptide antibiotic prophylaxis to determine whether there is evidence to guide antibiotic choice for surgical prophylaxis at different levels of MRSA prevalence 2) a systematic review of published economic evaluations, to examine the cost-effectiveness of glycopeptide antibiotics compared with appropriate comparators 3) a series of supplementary reviews, to support the modelling work and associated research recommendations 4) a modelling approach to estimate the cost-effectiveness of glycopeptide antibiotic prophylaxis relative to appropriate comparators, using orthopaedic surgery as an exemplar." (from executive summary)

Authors' recommendations: Implications for healthcare There is insufficient evidence to determine whether there is a threshold prevalence of MRSA at which switching from non-glycopeptide to glycopeptide antibiotic prophylaxis might be clinically effective and cost-effective. Recommendations for research Future research needs to address the complexities of decision-making relating to the prevention of MRSA and infection control in general. Focusing on MRSA alone is too limited and the prophylactic use of glycopeptides is only one aspect of infection control. Research including evidence synthesis and decision modelling comparing a full range of interventions for infection control, which extends to other infections, not just MRSA, is needed. A long-term research programme to predict the pattern of drug resistance and its implications for future costs and health is also needed.
Authors' methods: Systematic review
Details
Project Status: Completed
URL for project: http://www.hta.ac.uk/1505
Year Published: 2008
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Methicillin Resistance
  • Staphylococcus aureus
  • Glycopeptides
  • Staphylococcal Infections
  • Surgical Wound Infection
Contact
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
Contact Name: journals.library@nihr.ac.uk
Contact Email: journals.library@nihr.ac.uk
Copyright: 2009 Queen's Printer and Controller of HMSO
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.