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Executive Summary

Miles' Cipro (ciprofloxacin) has achieved widespread hospital formulary acceptance, with all of the 200 hospitals surveyed by Hospital Research Associates (HRA) including the broad spectrum oral quinolone on their formulary lists at the end of June. Launched in November 1987, Cipro had been accepted by 78% of hospital formularies after four months on the market and 95% after six months, according to HRA data. In a Aug. 29 release highlighting results of its June survey, HRA commented that "Cipro has demonstrated the most rapid formulary uptake of any product . . . in the five year history of (HRA's) audit." The Fairfield, New Jersey-based firm monitors formulary activity, including approvals, disapprovals and deletions, on a monthly basis from surveys of approximately 200 short-term general hospitals in the U.S. Since the launch of Cipro, approximately 14% of the surveyed hospitals have dropped Merck's Noroxin (the other currently approved oral fluoroquinolone) from their formularies. Noroxin, which is approved only for urinary tract infections, is listed by 63% of the surveyed formularies. Cipro is indicated for lower respiratory, skin and skin structure, bone and joint, and urinary tract infections as well as infectious diarrhea. HRA noted in its release that the drug "has exhibited significant usage in hospitals for numerous disorders including pneumonia, urinary tract infection, sepsis and osteomyelitis." The product, the release continues, "has replaced or displaced a number of drugs including, but not limited to SMX/TMP, second and third generation cephalosporins, ampicillin and aminoglycocides." By the end of June, Genentech's TPA product Activase (alteplase) was listed by approximately 83% of the surveyed formularies, "ranking second behind Cipro in quick formulary penetration," the survey states. However, HRA noted that "despite this level of performance, a significant number of hospitals accepting the product also continue to restrict its use, predominantly because of the drug's cost." While formularies have been quick to accept Activase, HRA data shows that hospitals continue to stock other thrombolytic agents. The survey data indicate that neither streptokinase (Hoechst's Streptase and KabiVitrum's Kabikinase) nor urokinase (Abbott's Abbokinase) were deleted by any of the surveyed hospitals after the November launch of Activase. Streptase is currently listed by 77% of the formularies, while Kabikinase, which is marketed in the U.S. by SmithKline, is listed by 46%, according to the survey. Abbokinase is on 58% of the surveyed hospitals' formulary lists. Merck and Stuart had similar formulary acceptance rates for their lisinopril products, Prinivil and Zestril, respectively. Launched in January, Prinivil was accepted by 23% of the surveyed hospitals while Zestril was accepted by 21% at the end of June. Prescription audit data reportedly put sales curves of the two second generation ACE inhibitor products in close proximity. The HRA survey comments that the brand that "will achieve greatest future success may largely be dependent upon promotional emphasis and/or dominance." Merck faces the challenge of positioning the product without cannibalizing sales of its first generation ACE Vasotec. Stuart also will face a marketing challenge with the upcoming approval of its I.V. anesthetic Diprivan (propofol). An NDA for the product was filed in 1986. Among other recent product introductions, the HRA data shows that Pfizer/Roerig's injectable sulbactam/ampicillin compound, Unasyn, had been approved by 63% of formularies after nine months of marketing and Glaxo's second generation oral cephalosporin Ceftin had been listed by 31% after three months marketing.

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