Pharmacy-implemented guidelines on switching from intravenous to oral antibiotics: an intervention study

Background: A high proportion of medical in-patients in the UK receive intravenous (IV) antibiotic therapy. This may be inappropriate in non-severe infections, or unnecessarily prolonged. Aim: To assess the impact of guideline implementation on IV antibiotic prescribing in medical admissions to a general hospital. Design: Observational intervention study. Methods: Data relating to infection and antibiotic therapy were collected for 4 weeks pre-intervention (group 1) and 4 weeks post intervention (group 2). Six months later, data were collected for a further 4 weeks following a second intervention (group 3). Interventions consisted of pharmacyled implementation of guidelines incorporating criteria for IV therapy and switching to the oral route. The second intervention also included pharmacy-initiated feedback on prescribing. The main outcome measures were IV antibiotic duration, and appropriateness of the IV route and switching. Results: Of 2365 admissions, 757 (32%) had 806 treated episodes. IV therapy was used in 40%, 46% and 36% (groups 1, 2 and 3, respectively) and was appropriate in 92% vs. 100% (group 1 vs. 2). In groups 2 and 3, oral switch timing was appropriate in 90% and 88%, vs. 17% in group 1 (p<0.001). Between groups 1 and 2, median duration of IV therapy was reduced from 3 to 2 days (p=0.01). More patients in group 2 received appropriate exclusively IV therapy (65% vs. 96%, p<0.01). Duration of stay in IV-treated patients reduced from 13 to 10 days in groups 2 and 3 (p=0.047). IV antibiotic expenditure reduced by 13% per patient admitted between groups 1 and 2. Discussion: Pharmacy-led introduction of antibiotic guidelines appears to result in clinically appropriate reductions in IV therapy.