Hospital pharmacists' reinforcement of guidelines for switching from parenteral to oral antibiotics: a pilot study.
OBJECTIVE
The cost of antibiotics in hospitals may be reduced by streamlining, and, particularly, by early switching from the intravenous (i.v.) to the oral route of administration. The aim of the study was to evaluate the feasibility and impact of guidelines for switching, reinforced by pharmacists.


METHODS
Patients admitted to internal medicine wards and treated with i.v. antibiotics for various infections were included for six weeks before (group A) and six weeks after (group B) the intervention. Differences in patient characteristics and their outcomes were sought between the two groups.


RESULTS
The 26 patients in group B stayed longer in hospital than the 29 in group A (13.3 vs. 9.7 days; P = 0.05). They also tended to need more time to reach the pre-defined criteria for switching (3.6 vs. 2.4 days; P = 0.09). From that point on, they were switched more rapidly to oral antibiotics (1.5 vs. 3.2 days; P = 0.02), which resulted in a trend toward a lower treatment cost until their discharge (44 vs. 92 euros; P = 0.08). No difference was found between the 2 groups for the duration of the i.v. therapy, or the total in-hospital cost of antibiotics.


CONCLUSIONS
Pharmacists may help implement and reinforce guidelines for switching to oral antibiotics. The evaluation of such interventions implies the choice of appropriate outcomes and the awareness of confounding factors.
von Gunten
Vera
V
Divisions of Pharmacy and Infectious Diseases, Central Institute of the Valais Hospitals, 86, Ave. Grand-Champsec, 1950, Sjon, Switzerland. vera.vongunten@ichv.ch
Amos
Viviane
V
Sidler
Anne-Laure
AL
Beney
Johnny
J
Troillet
Nicolas
N
Reymond
Jean-Philippe
JP
D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics; D017714:Community-Acquired Infections / Q000188:drug therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010607:Pharmacy Service, Hospital / Q000592:standards*; D010865:Pilot Projects; D017410:Practice Guidelines as Topic / Q000592:standards*; D024382:Professional Role; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents