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Sze WT, Kong MC. Impact of printed antimicrobial stewardship recommendations on early intravenous to oral antibiotics switch practice in district hospitals. Pharm Pract (Granada). 2018;16(2):855doi: 10.18549/PharmPract.2018.02.855.
Sze, W. T., & Kong, M. C. (2018). Impact of printed antimicrobial stewardship recommendations on early intravenous to oral antibiotics switch practice in district hospitals. Pharmacy practice, 16(2), 855. https://doi.org/10.18549/PharmPract.2018.02.855
Sze, Wei T, and Kong, Mei C. "Impact of printed antimicrobial stewardship recommendations on early intravenous to oral antibiotics switch practice in district hospitals." Pharmacy practice vol. 16,2 (2018): 855. doi: https://doi.org/10.18549/PharmPract.2018.02.855
Sze WT, Kong MC. Impact of printed antimicrobial stewardship recommendations on early intravenous to oral antibiotics switch practice in district hospitals. Pharm Pract (Granada). 2018 Apr-Jun;16(2):855. doi: 10.18549/PharmPract.2018.02.855. Epub 2018 Jun 17. PMID: 30023021; PMCID: PMC6041215.
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Pharm Pract (Granada). 2018 Apr-Jun;16(2):855. doi: 10.18549/PharmPract.2018.02.855. Epub 2018 Jun 17.

Impact of printed antimicrobial stewardship recommendations on early intravenous to oral antibiotics switch practice in district hospitals.

Pharmacy practice

Wei T Sze, Mei C Kong

Affiliations

  1. School of Pharmacy, University of London. London (United Kingdom). [email protected].
  2. Clinical Pharmacist. Pharmacy Department, Sibu Hospital. Sibu (Malaysia). [email protected].

PMID: 30023021 PMCID: PMC6041215 DOI: 10.18549/PharmPract.2018.02.855

Abstract

BACKGROUND: Early intravenous to oral (IV-PO) antibiotics switch, which is one of the important elements in antimicrobial stewardship (AMS) is not well implemented in Malaysian district hospitals. A systematic interventional strategy is required to facilitate IV-PO antibiotic switch.

OBJECTIVE: This study aimed to evaluate the impact of printed AMS recommendations on early IV-PO antibiotics switch practice in district hospitals.

METHODS: This study was an interventional study conducted in medical wards of eight Sarawak district hospitals from May to August 2015. In pre-intervention phase, pharmacists performed the conventional practice of reviewing medication charts and verbally informed the prescribers on eligible IV-PO switches. In post-intervention phase, pharmacists attached printed checklist which contained IV-PO switch criteria to patients' medical notes on the day patients were eligible for the switch. Stickers of IV-PO switch were applied to the antibiotic prescription to serve as reminders.

RESULTS: 79 and 77 courses of antibiotics were studied in the pre-intervention phase and post-intervention phase respectively. Timeliness of switch was improved by 1.63 days in the post-intervention phase (95%CI 1.26:2.00 days, p<0.001). Mean duration of IV antibiotics in the post-intervention phase was shorter than pre-intervention phase (2.81 days (SD=1.77) vs 4.05 days (SD=2.81), p<0.001). The proportion of IV-PO switches that were only performed upon discharge reduced significantly in the post-intervention phase (31.2% vs 82.3%, p<0.001). Length of hospital stay in the post-intervention phase was shortened by 1.44 days (p<0.001). Median antibiotic cost savings increased significantly in the post-intervention phase compared to the pre-intervention phase [MYR21.96 (IQR=23.23) vs MYR13.10 (IQR=53.76); p=0.025)].

CONCLUSIONS: Pharmacist initiated printed AMS recommendations are successful in improving the timeliness of IV-PO switch, reducing the duration of IV, reducing the length of hospitalisation, and increasing antibiotic cost savings.

Keywords: Anti-Bacterial Agents; Antimicrobial Stewardship; Drug Administration Routes; Evaluation Studies as Topic; Hospital; Malaysia; Pharmacists; Pharmacy Service

Conflict of interest statement

We attest that we have no financial or other relationships that could be construed as a conflict of interest for this study.

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