Pharmacy-implemented guidelines on switching from intravenous to oral antibiotics: an intervention study.
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.


OBJECTIVE
To assess the impact of guideline implementation on IV antibiotic prescribing in medical admissions to a general hospital.


METHODS
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.


CONCLUSIONS
Pharmacy-led introduction of antibiotic guidelines appears to result in clinically appropriate reductions in IV therapy.
McLaughlin
C M
CM
Department of Pharmacy, Stobhill Hospital, Glasgow, UK.
Bodasing
N
N
Boyter
A C
AC
Fenelon
C
C
Fox
J G
JG
Seaton
R A
RA
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017714:Community-Acquired Infections / Q000188:drug therapy*; D005260:Female; 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
D000900:Anti-Bacterial Agents