title: Implementing criteria-based early switch/early discharge programmes: a European perspective.
abstract: Early switch (ES) from intravenous (IV) to oral antibiotic therapy programmes is increasingly included as a component of hospital antimicrobial stewardship initiatives that aim to optimize antimicrobial therapy while limiting toxicity and resistance. In terms of prioritizing the most cost-effective stewardship interventions, ES has been seen as a 'low-hanging fruit', which refers to selecting the most obtainable targets rather than confronting more complicated issues. Administration of highly bioavailable oral antibiotics should be considered for nearly all non-critically ill patients and has been recommended as an effective and safe strategy for over two decades. However, to accrue the most benefit from ES, it should be combined with an early discharge (ED) plan, protocol, or care pathway. Benefits of this combined approach include improved patient comfort and mobility, reduced incidence of IV-line-related adverse effects, reduced IV antimicrobial preparation time, decreased hospital stays, reduced antimicrobial purchasing and administration costs, decreased patient deconditioning, and shortened recovery times. Results from published studies document decreases in healthcare resource use and costs following implementation of ES programmes, which in most studies facilitate the opportunity for ED and ED programmes. Barriers to the implementation of these programmes include clinician misconceptions, practical considerations, organizational factors, and a striking lack of awareness of IV to oral switch guidance. These and other barriers will need to be addressed to maximize the effectiveness of ES and ED programmes. As national antimicrobial stewardship programmes dictate the inclusion of ES and ED programmes within healthcare facilities, programmes must be developed and success must be documented.
authors.affiliation: Ninewells Hospital and Medical School, Dundee, UK.
authors.forename: D
authors.initials: D
authors.lastname: Nathwani
authors.affiliation: Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: W
authors.initials: W
authors.lastname: Lawson
authors.affiliation: Hampshire Hospitals NHS Foundation Trust, Winchester, Hampshire, UK.
authors.forename: M
authors.initials: M
authors.lastname: Dryden
authors.affiliation: Pharmerit International, Bethesda, MD, USA. Electronic address: jstephens@pharmerit.com.
authors.forename: J
authors.initials: J
authors.lastname: Stephens
authors.affiliation: Pharmerit International, Bethesda, MD, USA.
authors.forename: S
authors.initials: S
authors.lastname: Corman
authors.affiliation: Pharmerit International, Bethesda, MD, USA.
authors.forename: C
authors.initials: C
authors.lastname: Solem
authors.affiliation: Pfizer Inc., San Diego, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.affiliation: Pfizer Inc., Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Charbonneau
authors.affiliation: Pfizer Inc., Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Baillon-Plot
authors.affiliation: Pfizer Inc., Groton, CT, USA.
authors.forename: S
authors.initials: S
authors.lastname: Haider
authors.affiliation: Klinikum Peine, Academic Hospital of Medical University Hannover, Peine, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Eckmann
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D004358:Drug Therapy / Q000592:standards*; D005060:Europe; D017048:Health Care Costs; D006291:Health Policy; D006761:Hospitals; D006801:Humans; D007297:Inpatients; D010351:Patient Discharge; D055502:Secondary Prevention; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic stewardship; antibiotic switch; implementation; intravenous to oral switch; methicillin-resistant Staphylococcus aureus