Overutilization of intravenous (IV) medications can result in drug shortages, which is one of the major health care crisis, in addition to increasing costs, length of hospital stays (LOS) and the associated complications. We hypothesized that IV therapy was overused at our hospital where oral (PO) was applicable, and that the implementation of IV-PO protocol could result in a cost-effective practice. Hence, we aimed at assessing impact and outcomes of implementing such a protocol. A single center, prospective quasi-interventional study conducted at tertiary academic hospital. A protocol was implemented targeting 17 medications, with educational sessions to medical staff during a 5-month phase. IV orders of 48 h or more, among adult patients at medical or surgical wards with no contraindication to PO route were eligible. Once eligible, pharmacists send interventions using hospital’s computerized order entry system, and physicians’ responses were monitored on daily basis. Efficacy was estimated by percentage of switch recommendations that resulted in effective switch to PO medication. Cost-minimization analysis was used for course cost between the control phase and intervention phase. Length of hospital stay (LOS), readmissions within 90 days and in-hospital mortality were analyzed as secondary outcomes. During intervention phase, 781 patients had at least one IV order switched to PO. Gastric acid-reducing agents (GARAs) accounted for the most IV prescriptions (50.4%), followed by antibiotics (39.6%). Pharmacists carried out 2677 interventions to which switch recommendations were issued in 1185 (44.3%). Primary switch recommendations (N = 677) led to effective switch in 60.7% cases. These included per protocol switch (8.9%), switch to another PO (2.5%), spontaneous switch by physician (17.6%) and IV discontinuation (31.8%). The overall efficacy was estimated as 62.8%. The intervention was associated with reduced IV consumption from 4,574–18,597 vials in control phase to 3,654–15,546 vials in intervention phase, which resulted in overall cost saving of 50,960.8 SAR ($13,589.5), with an average monthly cost saving of 10,192.2 SAR ($2,717.9). Pharmacist-managed early switch from IV-PO therapy, with physicians’ education, showed significant reduction in IV medication use in our hospital. By reducing unnecessary IV use, this strategy enabled considerable cost savings, besides the potential advantages of convenience and safety.

Background. Community acquired pneumonia (CAP) is a common serious infection that is usually treated with a macrolide with a β-lactam while doxycycline is considered an alternative due to limited evidence. Hence, we aimed to evaluate azithromycin versus doxycycline containing regimen in achieving clinical stability for inpatients with CAP. Materials and Methods. a retrospective cohort of inpatients with CAP receiving either azithromycin or doxycycline combined with a β-lactam. The primary endpoint was the percentage of patients who achieved clinical stability within 3 days, while secondary endpoints were the average days required to achieve clinical stability. Results. A total of 447 were included of which 379 received azithromycin while 68 received doxycycline containing regimen. The average age of the study population was 65.4 ± 21.1, of which 49% were females. Ceftriaxone was the most prescribed β-lactam. Majority of this cohort had a length of hospital stay of 5 days or less. Total percentage of patients who achieved clinical stability within 3 days were 257 (57.5%), of which 222 (58.6%) were in azithromycin group versus 35 (51.5%) in doxycycline containing regimen group; p = 0.275 . While the average day required to achieve clinical stability in both groups was 3.8 ± 3.2, in which 3.8 ± 3.3 in azithromycin versus 3.9 ± 2.7 in doxycycline containing regimen; (95% CI −0.98–0.68; p = 0.727 ) Conclusions. These findings support that doxycycline is comparable in efficacy to macrolides with a β-lactam for inpatients with CAP as supported by current guideline recommendations.