Development of an intravenous-to-oral route conversion program for antimicrobial therapy at a Canadian tertiary care health facility.
OBJECTIVE
To describe the effect of introducing a route conversion program on the prescribing of antimicrobials for the treatment of respiratory tract infections and skin/soft tissue infections in a sample population.


METHODS
Concurrent, pre- and postintervention study.


METHODS
Four general internal medicine wards at The Toronto Hospital, a 1170-bed, tertiary care health center in Toronto, Ontario, Canada.


METHODS
Patients receiving antimicrobial therapy for respiratory tract infections and skin/soft tissue infections.


METHODS
Written guidelines and education sessions were presented to residents, interns, medical students, and pharmacists responsible for the care of patients admitted to four general internal medicine wards.


METHODS
Clinical and laboratory parameters related to the status of the infection were monitored prospectively and compared with the course of drug therapy, with consideration of the patient's ability to meet the criteria established in the guidelines. The number of days of intravenous therapy prescribed despite appropriateness of oral therapy was tallied.


RESULTS
Twenty-seven patients (28 infections) were identified for inclusion in the 7-week preliminary audit, and 30 patients (32 infections) were included in the audit after the program, which continued for 5 weeks. Following implementation of the program, the number of days that intravenous therapy was continued despite the appropriateness of oral therapy was reduced from 41% to 26% of the total days of intravenous therapy prescribed.


CONCLUSIONS
The program had a positive influence on antimicrobial prescribing behavior in the population studied. Strategies to ensure continued benefit from the program have been developed.
Zamin
M T
MT
Department of Pharmacy, Toronto Hospital, University of Toronto, Ontario, Canada.
Pitre
M M
MM
Conly
J M
JM
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use*; D002170:Canada; D003363:Cost Control; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects
D000890:Anti-Infective Agents