title: Development of operationalized intravenous to oral antibiotic switch criteria.
abstract: Despite huge overlap in suggested criteria for a safe intravenous (iv)-to-oral antibiotic switch, there is considerable variation in their operationalization. The objective of this study was to develop a set of measurable conditions that should be met in adult hospitalized patients for a safe iv-to-oral switch.
  
  
  
  A RAND-modified Delphi procedure was performed to develop a set of operationalized iv-to-oral switch criteria. Switch criteria and their accompanying suggested measurable conditions were extracted from the literature and appraised by a multidisciplinary expert panel during two questionnaire rounds with a face-to-face meeting between these two rounds. In a final step, the experts could approve the set of developed operationalized switch criteria.
  
  
  
  Seven switch criteria and 41 accompanying measurable conditions extracted from the literature were appraised. Sixteen measurable conditions that operationalize six switch criteria were selected: (i) stable systolic blood pressure; and the absence of (ii) fever, (iii) temperature <36°C, (iv) malabsorption syndrome, (v) short bowel syndrome, (vi) severe gastroparesis, (vii) ileus, (viii) continuous nasogastric suction, (ix) vomiting, (x) (severe) sepsis, (xi) fasciitis necroticans, (xii) CNS infection, (xiii) Staphylococcus aureus bacteraemia, and (xiv) endovascular infection. In addition, (xv) the patient should be cooperative and (xvi) adequate antimicrobial concentration should be achievable at the site of infection by oral administration.
  
  
  
  These operationalized criteria can be used in daily clinical practice. Future use of these criteria in audits and as rules in clinical decision support systems will facilitate the performance and evaluation of iv-oral switch programmes.
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands h.akhloufi@erasmusmc.nl.|Department of Internal Medicine, Division of Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Akhloufi
authors.affiliation: Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Hulscher
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: D C
authors.initials: DC
authors.lastname: Melles
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Prins
authors.affiliation: Department of Hospital Pharmacy, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: van der Sijs
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.|Department of Internal Medicine, Division of Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Verbon
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology; D006760:Hospitalization; D006801:Humans; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents