QJM Advance Access originally published online on August 26, 2005
QJM 2005 98(10):745-752; doi:10.1093/qjmed/hci114
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Pharmacy-implemented guidelines on switching from intravenous to oral antibiotics: an intervention study
From the Departments of 1Pharmacy and 4Medicine, Stobhill Hospital, Glasgow, 2Infectious Diseases Unit, Brownlee Centre, Gartnavel General Hospital, Glasgow, and 3Department of Pharmaceutical Sciences, University of Strathclyde, Glasgow, UK
Address correspondence to Dr R.A. Seaton, Consultant Physician, Brownlee Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN. email: andrew.seaton{at}northglasgow.scot.nhs.uk
Received 4 March 2005 and in revised form 12 July 2005
Background: A high proportion of medical in-patients in the UK receive intravenous (IV) antibiotic therapy. This may be inappropriate in non-severe infections, or unnecessarily prolonged.
Aim: To assess the impact of guideline implementation on IV antibiotic prescribing in medical admissions to a general hospital.
Design: Observational intervention study.
Methods: Data relating to infection and antibiotic therapy were collected for 4 weeks pre-intervention (group 1) and 4 weeks post intervention (group 2). Six months later, data were collected for a further 4 weeks following a second intervention (group 3). Interventions consisted of pharmacy-led implementation of guidelines incorporating criteria for IV therapy and switching to the oral route. The second intervention also included pharmacy-initiated feedback on prescribing. The main outcome measures were IV antibiotic duration, and appropriateness of the IV route and switching.
Results: Of 2365 admissions, 757 (32%) had 806 treated episodes. IV therapy was used in 40%, 46% and 36% (groups 1, 2 and 3, respectively) and was appropriate in 92% vs. 100% (group 1 vs. 2). In groups 2 and 3, oral switch timing was appropriate in 90% and 88%, vs. 17% in group 1 (p<0.001). Between groups 1 and 2, median duration of IV therapy was reduced from 3 to 2 days (p = 0.01). More patients in group 2 received appropriate exclusively IV therapy (65% vs. 96%, p<0.01). Duration of stay in IV-treated patients reduced from 13 to 10 days in groups 2 and 3 (p = 0.047). IV antibiotic expenditure reduced by 13% per patient admitted between groups 1 and 2.
Discussion: Pharmacy-led introduction of antibiotic guidelines appears to result in clinically appropriate reductions in IV therapy.
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  D. Mertz, M. Koller, P. Haller, M. L. Lampert, H. Plagge, B. Hug, G. Koch, M. Battegay, U. Fluckiger, and S. Bassetti Outcomes of early switching from intravenous to oral antibiotics on medical wards J. Antimicrob. Chemother., July 1, 2009; 64(1): 188 - 199. [Abstract] [Full Text] [PDF]
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