Majority of the patients admitted to a hospital with severe infections are initially started with intravenous medications. Short intravenous course of therapy for 2-3 days followed by oral medications for the remainder of the course is found to be beneficial to many patients. This switch over from intravenous to oral therapy is widely practiced in the case of antibiotics in many developed countries. Even though intravenous to oral therapy conversion is inappropriate for a patient who is critically ill or who has inability to absorb oral medications, every hospital will have a certain number of patients who are eligible for switch over from intravenous to oral therapy. Among the various routes of administration of medications, oral administration is considered to be the most acceptable and economical method of administration. The main obstacle limiting intravenous to oral conversion is the belief that oral medications do not achieve the same bioavailability as that of intravenous medications and that the same agent must be used both intravenously and orally. The advent of newer, more potent or broad spectrum oral agents that achieve higher and more consistent serum and tissue concentration has paved the way for the popularity of intravenous to oral medication conversion. In this review, the advantages of intravenous to oral switch over therapy, the various methods of intravenous to oral conversion, bioavailability of various oral medications for the switch over program, the patient selection criteria for conversion from parenteral to oral route and application of intravenous to oral switch over through case studies are exemplified.
The impact of educational interventions on physicians by clinical pharmacists for early switchover of parenteral drugs to oral therapy was evaluated prospectively in 340 patients receiving parenteral medications in a tertiary care teaching hospital. Patients switched over from parenteral to oral therapy within the appropriate time increased from 48.2% in the preintervention group to 78.8% in the postintervention group (p=0.000). Significant reduction in duration of hospital stay (p=0.005) and mean cost of therapy (p=0.021) was observed in patients in the postintervention group. The mean knowledge score obtained by physicians increased in the postintervention phase (p=0.000). Educational interventions on the physicians by clinical pharmacists and implementation of locally developed guidelines can facilitate early switchover of parenteral medications to oral therapy. This, in turn, can reduce duration of parenteral medication use, cost of drug therapy, length of hospital stay and, eventually, the total cost of treatment.
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