Practice of switch from intravenous to oral antibiotics

Abstract

Hospitalized patients initially on intravenous antibiotics can be safely switched to an oral equivalent within the third day of admission once clinical stability is established. This conversion has many advantages as fewer complications, less healthcare costs and earlier hospital discharge. The three types of intravenous to oral conversion include sequential, switch, and step-down therapy. The aim of the study was to evaluate the practice of switching from intravenous to oral antibiotics, its types and its impact on the clinical outcomes. This was a retrospective observational study conducted in three Lebanese hospitals over a period of six months. Adult inpatients on intravenous antibiotics for 2 days and more were eligible for study enrollment. Excluded were patients admitted to care or surgery units, or those with gastrointestinal diseases, infections that require prolonged course of parenteral therapy, or malignancies.The study showed that among 452 intravenous antibiotic courses from 356 patients who were eligible for conversion, only one third were switched and the others continued on intravenous antibiotics beyond day 3 (P <0.0001). The mean duration of intravenous therapy of converted patients was markedly shorter than the non-converted (P <0.0001) with no significant change in the mean length of stay. Fluoroquinolones and macrolides were the most commonly converted antibiotics. However, the sequential therapy was the major type of conversion practiced in this study. Based on the study findings, a significant proportion of patients can be considered for switch. This emphasizes an important gap in the field of conversion from intravenous to oral antibiotic therapy and the need for integration and reinforcement of the appropriate Antibiotic Stewardship Programs in hospitals.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-3-717) contains supplementary material, which is available to authorized users.

Parenteral Antibiotic Usage Patterns and Effects of Intravenous to Oral Switching on the Length and Cost of Hospitalization

“…There are also doctors who prescribe switching based on the patient's clinical conditions, such that it is done earlier. Some studies suggest that the optimal time for switching is the 2 nd to 4 th day of intravenous antibiotics [6,15,16]. The study did not observe any patients who relapsed or required intravenous antibiotics again after switching.…”

“…However, the decrease in the length of hospitalization was not found to be statistically significant. A retrospective observational study in Lebanon [6] reported that the duration of intravenous antibiotics administered in the switching group was shorter than that in the nonswitching group. The length of hospitalization in the switching group was shorter than in the switching group, but these results were not significant either.…”

“…Antibiotics are usually administered intravenously at the beginning of hospitalization to provide optimal concentration [4]. About one-third of patients receiving antibiotics intravenously are eligible for switching to oral antibiotics [5,6].…”

Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department

“…), and possibly earlier discharge . A conservative estimate of 2 days saved of IV therapy is likely appropriate given the previous literature …”

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

“…The pharmacokinetic profile is similar between oral and intravenous formulations, allowing for easy conversions between the formulations. However, antimicrobials are frequently delivered intravenously in hospitalized patients even if they are capable of taking oral medications [11]. Furthermore, the intervention for conversion of routes of administration to reduce the length of hospital stay and cost is not frequently performed in Korea.…”