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.
What this study adds:
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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