Intravenous and oral antibiotics in respiratory tract infection: an international observational study of hospital practice.
BACKGROUND
Hospitalised patients with respiratory tract infections (RTI) frequently receive intravenous (i.v.) antibiotics followed by a short course of oral treatment.


OBJECTIVE
To observe antibiotic use in hospitals in Germany, Spain, France, Italy and the UK and the reasons for choosing the i.v. route and switching to oral treatment.


METHODS
Research pharmacists sought the opinions of physicians and senior nurses in the completion of a semi-structured questionnaire on the treatment of RTI with i.v. antibiotics. Questions focussed on antimicrobials of choice, reasons for choosing i.v., reasons for changing to oral administration, and duration of treatment.


RESULTS
This study recruited 796 patients with RTI, usually pneumonia. Prescribing patterns varied widely between the five hospitals. Accepted clinical criteria were only commonly cited in Germany, Spain and the UK as reasons for choosing the i.v. route at the beginning of the study. These were more commonly cited at the time of switch, although other criteria such as improved condition, were other significant reasons. The mean duration of i.v. treatment ranged from 4 days in the UK to 10 days in Italy, where most patients received the full course of treatment by the i.v. route. Unlike the other hospitals studied, the few patients in Italy who were switched to another form of treatment were as likely to receive intramuscular as oral administration (13% and 11%, respectively).


CONCLUSIONS
The practice of and reasons for prescribing i.v. antibiotics varied in the hospitals studied. Objective clinical criteria were inconsistently cited as reasons for administering i.v. antibiotics and in general these reasons were unrelated to those given for the switch from i.v. to oral administration. In order for guidelines for switching from i.v. to oral antimicrobials to be routinely employed, explicit physiological criteria need to be recorded in a routine fashion. Closer co-operation between pharmacists and physicians may help in developing and implementing guidelines at a local level.
Cooke
J
J
South Manchester University Hospitals NHS Trust, Withington Hospital, Manchester, UK. jonathan.cooke@man.ac.uk
Kubin
M
M
Morris
T
T
Ribas
J
J
Krämer
I
I
Kämmerer
W
W
Fornaini
R
R
Ballet
A C
AC
Sagnier
P P
PP
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007262:Infusions, Intravenous; D038622:Internationality; D008297:Male; D008875:Middle Aged; D019370:Observation / Q000379:methods; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology
D000900:Anti-Bacterial Agents