Clinical and economic impact of a pharmacistmanaged i.v.-to-p.o. conversion service for levofloxacin in Taiwan

Yen, Yu-Hsuan; Chen, Hsiang-Yin; Leu, Wuan-Jin; Lin, You-Meei; Shen, Wan Chen; Cheng, Kuei-Ju

doi:10.5414/cp201579

Cited by 33 publications

(33 citation statements)

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“…Antimicrobial costs were reduced by €6.21 per patient. A study focusing on iv to po switching of levofloxacin in Taiwan, reported a reduction in total inpatient expenditure of US$2,446.9 [22]. Pharmacist provided antibiotic review services, showed overall cost savings in a US hospital but did not result in any significant reductions in cost per patient between control and intervention groups [20].…”

Section: Antimicrobial Managementmentioning

confidence: 98%

“…Five of the studies included a comparator, either in the form of a randomised controlled trial [19] or a pre-and post- intervention comparison [17,18,20,22]. One study was a prospective audit [21].…”

Section: Antimicrobial Managementmentioning

confidence: 99%

“…Interventions were in following areas antimicrobial management [17][18][19][20][21][22], targeted drug programmes [23][24][25][26], multidimensional clinical pharmacy service [27][28][29], paediatric programmes [30,31], renal specialist [32,33], pharmacotherapeutic optimisation [34,35], intensive care service [36,37] and neurosurgery [38]. All intervention types have been identified in previous reviews of the literature [10][11][12][13].…”

Section: Clinical Pharmacy Interventionsmentioning

confidence: 99%

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Economic evaluations of clinical pharmacist interventions on hospital inpatients: a systematic review of recent literature

2014

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Section: Antimicrobial Managementmentioning

confidence: 98%

Section: Antimicrobial Managementmentioning

confidence: 99%

Section: Clinical Pharmacy Interventionsmentioning

confidence: 99%

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Economic evaluations of clinical pharmacist interventions on hospital inpatients: a systematic review of recent literature

2014

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“…Oral levofloxacin and ornidazole have near 100 percent bioavailability; therefore a comparable exposure to the i.v. regimen may be achieved after oral administration [18,19]. i.v.…”

Section: Discussionmentioning

confidence: 99%

An outpatient antibacterial stewardship intervention during the journey to JCI accreditation

Song

Zhou

2014

BMC Pharmacol Toxicol

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BackgroundAntibacterial overuse, misuse and resistance have become a major global threat. The Joint Commission International (JCI) accreditation standards include quality improvement and patient safety, which is exemplified by antimicrobial stewardship. There are currently few reports on interventions to improve the quality of outpatient antibacterial prescribing.MethodsA before-after intervention study, aiming at antibacterial use in outpatients, was performed in a university-affiliated hospital with 2.8 million outpatient visits annually during the journey to JCI accreditation (March of 2012 - March of 2013). Comprehensive intervention measures included formulary adjustment, classification management, motivational, information technological, educational and organizational measures. A defined daily dose (DDD) methodology was applied. Pharmacoeconomic data and drug-related problems (DRPs) were statistically compared between the two phases.ResultsThe variety of antibacterials available in outpatient pharmacy decreased from 38 to 16. The proportion of antibacterial prescriptions significantly decreased (12.7% versus 9.9%, P < 0.01). The proportion of prescriptions containing the restricted antibacterials was 30.4% in the second phase, significantly lower than the value of 44.7% in the first phase (P < 0.01). The overall proportion of oral versus all antibacterial prescriptions increased (94.0% to 100%, P < 0.01) when measured as defined daily doses. Statistically significant increases in relative percentage of DDDs of oral antibacterials (i.e., DDDs of individual oral antibacterial divided by the sum of DDDs of all antibacterials) were observed with moxifloxacin, levofloxacin, cefuroxime axetil, ornidazole, clindamycin palmitate, cefaclor, amoxicillin and clarithromycin. Occurrence rate of DRPs decreased from 13.6% to 4.0% (P < 0.01), with a larger decrease seen in surgical clinics (surgical: 19.5% versus 5.6%; internal medicine: 8.4% versus 2.8%, P < 0.01). The total expenditure on antibacterials for outpatients decreased by 34.7% and the intervention program saved about 6 million Chinese Yuan Renminbi (CNY) annually.ConclusionThe one-year intervention program on outpatient antibacterial use during the journey to JCI accreditation reduced the expenditure on antibacterials, improved the appropriateness of antibacterial prescriptions. Quality improvements need integrated multifaceted intervention measures and long-term adherence to the antibiotic stewardship. Approach of i.v. to oral antibacterial switch, classification management, and motivational measures may play the most efficient role in changing antibacterial prescription practices.

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“…Ho et al showed in their study that the conversion from intravenous to oral administration of ciprofloxacin by pharmacists led to a 23% reduction in unnecessary prescription of intravenous medications and subsequently, healthcare costs [6]. Furthermore, Yen's study on the conversion from intravenous to oral administration of levofloxacin resulted in a reduction of 11.1 days of in the length of hospitalization and 40% reduction in the total cost of hospitalization after the intervention [7]. …”

Section: Introductionmentioning

confidence: 99%

Impact of Intervention by an Antimicrobial Stewardship Team on Conversion from Intravenous to Oral Fluoroquinolones

et al. 2017

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BackgroundEarly conversion from intravenous to oral antibiotics plays an important role in lowering the risk of catheter-associated infections, reducing the workload of nurses, decreasing direct and indirect costs, and shortening hospital stays. In August 2015, an antimicrobial stewardship program (ASP) was implemented to facilitate conversion from intravenous to oral administration of fluoroquinolones in our institute. This study evaluated the clinical and economic impact of the intervention.Materials and MethodsData were retrospectively collected by reviewing electronic medical records. All hospitalized patients aged 18 and older who met the study inclusion criteria for the conversion were included between August and November 2015. We computed the physicians' adherence rate to the ASP recommendations. We also measured the total use of fluoroquinolones, length of hospital stay, and medication costs.ResultsDuring 4 months, 129 cases were enrolled in the study. The adherence rate was 79.8%. The average total prescription volume of intravenous fluoroquinolones, the length of hospital stay, and the total cost of the fluoroquinolones statistically significantly decreased in the intervention-adherent group.ConclusionIntervention to facilitate conversion from intravenous to oral administration has reduced excess use of intravenous fluoroquinolones and length of hospital stay. With these findings, further implementations of the ASP extending to other antibiotics may be warranted.

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Clinical and economic impact of a pharmacistmanaged i.v.-to-p.o. conversion service for levofloxacin in Taiwan

Cited by 33 publications

References 0 publications

Economic evaluations of clinical pharmacist interventions on hospital inpatients: a systematic review of recent literature

Economic evaluations of clinical pharmacist interventions on hospital inpatients: a systematic review of recent literature

An outpatient antibacterial stewardship intervention during the journey to JCI accreditation

Impact of Intervention by an Antimicrobial Stewardship Team on Conversion from Intravenous to Oral Fluoroquinolones

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