Author for correspondence:
Sharmila Khumra
Departments of Pharmacy and Infectious Diseases
Level 7, Harold Stokes Building
Austin Health
145 Studley Road,
Heidelberg, Victoria, 3084
Australia
Telephone number: +61 3 9496 5000
Fax number: +61 3 9496 6676
E-mail:
sharmila.khumra@austin.org.au
Running head: IV-oral antimicrobial switch evaluation
Keywords: Antimicrobials; antimicrobial stewardship; switch
therapy; preauthoriziation; guidelines; hospital
Word count: section d only: 1574 words; sections b, c, d: 1842
words
Table count: 2
Figure count: 1
What is already known about this subject:
Timely intravenous (IV) to oral antimicrobial switch (IV-oral-switch)
has proven benefits for patients and hospitals. However, timely
IV-oral-switch only occurs in approximately half of eligible patients.
Previous studies examining strategies to improve IV-oral-switch were
typically undertaken shortly after IV-oral-switch interventions were
implemented. It is not known whether the reported benefits reflect
longer-term outcomes, especially in the context of a long-standing,
tightly regulated antimicrobial stewardship (AMS) program.
- Our results suggest a multifaceted AMS approach that includes
guidelines and a preauthorisation system with short duration of
approvals for target antimicrobials is associated with sustained good
IV-oral-switch practice.
- The total duration of therapy (IV plus oral) was identified as an area
for improvement.
Abstract
Timely intravenous (IV) to oral antimicrobial switch (IV-oral-switch) is
a key antimicrobial stewardship (AMS) strategy. A retrospective audit
was undertaken to determine concordance with IV-oral-switch guidelines
in the context of a long-standing, tightly regulated AMS program. Data
from 107 general medical and surgical patients in an Australian hospital
were analysed. Median duration of IV antimicrobial courses before
switching to oral therapy was 3 days (interquartile range, 2.25-5.00).
Timely IV-oral-switch occurred in 57% (n =61) of patients. The
median delay to switching was 0 days (IQR 0 to 1.25). In most courses
(92/106, 86.8%), the choice of oral alternative after switching was
appropriate. In 45% (47/105) of courses, total duration of therapy (IV
plus oral) exceeded the recommended duration by >1.0 day.
Excessive IV antimicrobial duration was uncommon at a hospital with a
tightly regulated AMS program. Total duration of therapy was identified
as an AMS target for improvement.
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