Early switch from intravenous to oral antibiotics: guidelines and implementation in a large teaching hospital

In recent years 'switch therapy' has been advocated: short intravenous anti biotic therapy, for 2-3 days, followed by oral treatment for the remainder of the course. Little is known about the number of patients that could bene fit from early switch therapy and the consequences of introducing this stra tegy in everyday practice. We prospectively registered all antibiotic cours es on wards for Internal Medicine, Surgery, and Pulmonology during a 2 mont h period, before (n = 362, inventorial phase) and after (n = 281, implement ation phase) the introduction of guidelines for switching therapy. Approxim ately 40% of all patients who started on iv antibiotics were candidates for an early iv-oral switch. During the inventorial phase, 54% (52/97) of elig ible patients were switched to oral treatment, after a median of 6 days (ra nge 2-28 days). After implementation of the guidelines, this percentage ros e to 83% (66/80) (difference 29%, 95% CI 16-42%; P < 0.001). Therapy was al so switched earlier, after a median of 4 days (range 2 to 16 days). In the 6 weeks after completion of the oral course, recurrence of infections, or r eadmissions due to reinfections did not occur. Compared with the inventoria l phase, 43% of iv administrations could be avoided, that is >6000 per year . This means a potential annual reduction of dfl.60,000 (c. US$30,000) of a dministration costs. The potential savings in purchase costs of the antibio tics were dfl.54,000 (US$27,000) annually. In conclusion, a substantial num ber of patients starting on iv antibiotics were candidates for an early iv- oral switch. The guidelines were well accepted by the physicians and substa ntial savings in costs and nursing time were achieved.