title: A randomized, prospective evaluation of an interventional program to discontinue intravenous antibiotics at two tertiary care teaching institutions.
abstract: To evaluate a program to discontinue intravenous antibiotics at two teaching hospitals, 102 inpatients meeting eligibility criteria were randomly assigned to two groups. In one group, patients' physicians were contacted by pharmacists with recommendations to discontinue intravenous antibiotic therapy; in the other, patients were simply observed. Measured outcomes were antibiotic costs, length of stay, need to restart intravenous antibiotics, in-hospital mortality, and 30-day readmissions. The intervention significantly reduced mean antibiotic costs per patient ($19.82 vs $35.84, p = 0.03), but related labor costs exceeded this benefit. Readmissions were significantly more frequent in the intervention group than in the control group (29% vs 9.8% p = 0.02), but they were not infection related. No impact was demonstrated on the other measured outcomes. Institutions considering such programs or with one in place should conduct similar evaluations.
authors.affiliation: Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: T C
authors.initials: TC
authors.lastname: Bailey
authors.forename: D J
authors.initials: DJ
authors.lastname: Ritchie
authors.forename: S T
authors.initials: ST
authors.lastname: McMullin
authors.forename: M
authors.initials: M
authors.lastname: Kahn
authors.forename: R M
authors.initials: RM
authors.lastname: Reichley
authors.forename: E
authors.initials: E
authors.lastname: Casabar
authors.forename: W
authors.initials: W
authors.lastname: Shannon
authors.forename: W C
authors.initials: WC
authors.lastname: Dunagan
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D003141:Communicable Diseases / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D003365:Costs and Cost Analysis; D016527:Drug Costs; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007275:Injections, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008923:Missouri; D010595:Pharmacists; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents