The Antimicrobial Stewardship Program (ASP) team at the National University Hospital (NUH) Singapore has compiled intravenous to oral (IV-to-PO) antibiotics conversion guidelines and conducted training sessions with pharmacists on IV-to-PO conversion. The primary aim of this study was to assess compliance with IV-to-PO guidelines, pre-and post-implementation of training, and to evaluate the acceptance rate and timeliness of pharmacist interventions for IV-to-PO antibiotic conversion. A chart-review study for two cohorts of patients newly prescribed IV clindamycin or metronidazole was conducted over two 6-week periods following training sessions detailing hospital recommendations for converting suitable patients to oral therapy. Cases were reviewed to compare IV-to-PO interventions by the end of 7 days and review the effectiveness of training and timeliness of any pharmacist intervention. There was no difference in proportion of patients suitable, but not converted to oral therapy by the end of 1 week (41/125 vs 30/115, p = 0.255) following the training session. There was also no significant difference in documented IV-to-PO antibiotic intervention rates (3/41 vs 5/30, p = 0.18) by pharmacists. Few pharmacists are actively intervening to convert patients from IV-to-PO antibiotics. Training was ineffective in improving intervention rates. These results show that the ASP team needs to come up with better strategies to ensure timely interventions for IV-to-PO antibiotic conversion.
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