title: Implementation of intravenous to oral antibiotic switch therapy guidelines in the general medical wards of a tertiary-level hospital in South Africa.
abstract: OBJECTIVE
  The design and implementation of an antibiotic intravenous (iv) to oral switch therapy (IVOST) guideline in a Third World health setting.
  
  
  METHODS
  The guideline was developed and integrated into daily practice by a ward pharmacist over a period of 7 weeks. Patients were switched once they were deemed clinically stable according to IVOST criteria. The final decision to switch was left to the attending physician. One pre- and two post-implementation audits (150 patient medical records per audit) were compared.
  
  
  RESULTS
  Implementation of the IVOST guideline was successful in increasing (P<0.0005) the number of patients switched from 16% (19/119) pre-implementation to 43.9% (47/107) immediately after implementation; however, the change was not sustained 3 months after implementation (20.8%; 25/120). The intervention was also successful in decreasing the overall duration of iv therapy (P<0.0005) from 7.2 ± 3.5 days pre-implementation to 5.2 ± 3.0 days immediately post-implementation. The change was not sustained 3 months after implementation (6.5 ± 3.5 days).
  
  
  CONCLUSIONS
  Despite the challenges encountered in a Third World environment, an antibiotic IVOST guideline can be successfully implemented. Continual, active integration of the guideline into daily practice by a ward pharmacist is essential if positive IVOST outcomes are to be maintained.
authors.affiliation: Department of Pharmacy, Nelson Mandela Metropolitan University, Summerstrand, Port Elizabeth, South Africa. anidavn@gmail.com
authors.forename: Anida C
authors.initials: AC
authors.lastname: van Niekerk
authors.forename: Daniel J L
authors.initials: DJ
authors.lastname: Venter
authors.forename: Shirley-Anne
authors.initials: SA
authors.lastname: Boschmans
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000188:drug therapy*; D003428:Cross Infection / Q000517:prevention & control*; D004358:Drug Therapy / Q000379:methods* / Q000592:standards*; D005260:Female; D017408:Guidelines as Topic; D006302:Health Services Research; D006761:Hospitals; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D013019:South Africa; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents