The effect of intravenous-to-oral switch guidelines on the use of parenteral antimicrobials in medical wards

Abstract

The effect of an intravenous (i.v.)-to-oral switch policy on antibiotic prescribing in general medical wards was examined. Three audits, each of 2 months' duration, were carried out to examine the duration of i.v. therapy and length of patient stay. The first audit (S1) was performed before the introduction of switch guidelines, the second (S2) after guidelines had been placed in patient case-notes and the third (S3) after the guidelines had been introduced into the drug charts. The duration of i.v. therapy was significantly shorter in the S3 group (mean = 3.7 days) than in the S2 or S1 groups (mean 4.4 and 4.35 days, respectively) (P < 0.05). There was no significant difference in the length of patient stay between the three audit periods but the stay was significantly shorter in 81 switched patients (mean duration = 8.9 days) than in matched controls (mean duration = 12.6 days) (P = 0.01). Fewer patients with respiratory infection were treated for > 24 h with i.v. antimicrobials in the S3 audit period (75/549) than in the S2 (85/372) and S1 audits (83/326) (P < 0.01). The introduction of switch guidelines to drug charts reduces the length of i.v. therapy. Switched patients spend less time in hospital than their matched controls.

Implementing a pharmacist-led sequential antimicrobial therapy strategy: a controlled before-and-after study

“…This study included a control and intervention group in both phases, following recommendations from Ramsay et al [14]. This contrasts with other published studies, which used an uncontrolled before and after design, with no control group included in the post-intervention phase of the study [4][5][6][7][8][9][10][11][12][13]. The methodology used in this study continues to demonstrate the utility of a systematic plan for switching to PO antimicrobials, as recommended by the IDSA [2].…”

“…Additionally, nursing time spent preparing IV doses is reduced and patient comfort and mobility is improved [3]. Initiatives to promote sequential therapy have also been shown to reduce the duration of IV treatment and hospital stay with resulting cost savings [4][5][6][7][8][9][10][11][12][13]. For these reasons, 'antimicrobial switch strategy' criteria and guidelines were implemented in a 753 bed university hospital in Dublin, Ireland.…”

“…Several studies have shown successful implementation of a sequential therapy strategy in medical patients requiring IV antimicrobials, with reductions in expenditure and length of hospital stay [4][5][6][7][8][9][10][11][12][13]. However, a major limitation has been the uncontrolled design of these studies.…”

Implementation of guidelines for sequential therapy with fluoroquinolones in a Belgian hospital

“…Sequential therapy is defined as conversion from intravenous to oral formulation of the same medication while maintaining equivalent potency [2]. Several advantages have been associated with this strategy: less preparation time, easier drug administration, patient comfort, lower risk of bacteraemia and thrombophlebitis, savings in antibiotic costs and potential shortening of the length of hospital stay [2][3][4][5][6][7][8][9][10][11][12][13][14]. Several clinical trials have demonstrated the efficacy of sequential therapy [11][12][13][14].…”

Optimización del tratamiento antibiótico mediante la participación de expertos en antibióticos

“…Utilizar la vía oral desde el principio es posible con algunos fármacos con excelente biobisponibilidad como clindamicina, metronidazol o fluoroquinolonas (2,14,19,20).…”