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      Intravenous-to-oral antibiotic switch therapy: a cross-sectional study in critical care units

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          Abstract

          Background

          This study aimed to evaluate the oral switch (OS) stewardship intervention in the intensive care unit (ICU).

          Methods

          This was a retrospective study with a convenience sample in two Brazilian ICUs from different hospitals in patients with sepsis receiving antibiotic therapy. The stewardship intervention included OS in patients diagnosed with sepsis when clinical stability was achieved. The primary outcome was overall mortality. Other variables evaluated were as follows: cost of antimicrobial treatment, daily costs of intensive care, acute kidney injury, and length of stay.

          Results

          There was no difference in mortality between the OS and non-OS groups ( p = 0.06). Length of stay in the ICU ( p = 0.029) was shorter and acute kidney injury incidence ( p = 0.032) and costs of antimicrobial therapy ( p < 0.001) were lower in the OS group.

          Conclusion

          OS stewardship programs in the ICU may be considered a safe strategy. Switch therapy reduced the cost and shortened the length of stay in ICUs.

          Electronic supplementary material

          The online version of this article (10.1186/s12879-019-4280-0) contains supplementary material, which is available to authorized users.

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          Most cited references23

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          Trial of short-course antimicrobial therapy for intraabdominal infection.

          The successful treatment of intraabdominal infection requires a combination of anatomical source control and antibiotics. The appropriate duration of antimicrobial therapy remains unclear.
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            Switch over from intravenous to oral therapy: A concise overview

            Majority of the patients admitted to a hospital with severe infections are initially started with intravenous medications. Short intravenous course of therapy for 2-3 days followed by oral medications for the remainder of the course is found to be beneficial to many patients. This switch over from intravenous to oral therapy is widely practiced in the case of antibiotics in many developed countries. Even though intravenous to oral therapy conversion is inappropriate for a patient who is critically ill or who has inability to absorb oral medications, every hospital will have a certain number of patients who are eligible for switch over from intravenous to oral therapy. Among the various routes of administration of medications, oral administration is considered to be the most acceptable and economical method of administration. The main obstacle limiting intravenous to oral conversion is the belief that oral medications do not achieve the same bioavailability as that of intravenous medications and that the same agent must be used both intravenously and orally. The advent of newer, more potent or broad spectrum oral agents that achieve higher and more consistent serum and tissue concentration has paved the way for the popularity of intravenous to oral medication conversion. In this review, the advantages of intravenous to oral switch over therapy, the various methods of intravenous to oral conversion, bioavailability of various oral medications for the switch over program, the patient selection criteria for conversion from parenteral to oral route and application of intravenous to oral switch over through case studies are exemplified.
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              Antibiotic Stewardship Ward Rounds and a Dedicated Prescription Chart Reduce Antibiotic Consumption and Pharmacy Costs without Affecting Inpatient Mortality or Re-Admission Rates

              Background Antibiotic consumption is a major driver of bacterial resistance. To address the increasing burden of multi-drug resistant bacterial infections, antibiotic stewardship programmes are promoted worldwide to rationalize antibiotic prescribing and conserve remaining antibiotics. Few studies have been reported from developing countries and none from Africa that report on an intervention based approach with outcomes that include morbidity and mortality. Methods An antibiotic prescription chart and weekly antibiotic stewardship ward round was introduced into two medical wards of an academic teaching hospital in South Africa between January-December 2012. Electronic pharmacy records were used to collect the volume and cost of antibiotics used, the patient database was analysed to determine inpatient mortality and 30-day re-admission rates, and laboratory records to determine use of infection-related tests. Outcomes were compared to a control period, January-December 2011. Results During the intervention period, 475.8 defined daily doses were prescribed per 1000 inpatient days compared to 592.0 defined daily doses/1000 inpatient days during the control period. This represents a 19.6% decrease in volume with a cost reduction of 35% of the pharmacy’s antibiotic budget. There was a concomitant increase in laboratory tests driven by requests for procalcitonin. There was no difference in inpatient mortality or 30-day readmission rate during the control and intervention periods. Conclusions Introduction of antibiotic stewardship ward rounds and a dedicated prescription chart in a developing country setting can achieve reduction in antibiotic consumption without harm to patients. Increased laboratory costs should be anticipated when introducing an antibiotic stewardship program.
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                Author and article information

                Contributors
                julianogasparetto@gmail.com
                55-41-3271-1555 , flptuon@gmail.com
                santos.dayana@hospitalcajuru.com.br
                zequinao.tiago@hospitalcajuru.com.br
                ga.rammert@gmail.com
                gabrielsenes@hotmail.com
                paolabeninca@hotmail.com
                cruz.june@grupomarista.com.br
                thyagomoraes@hotmail.com
                Journal
                BMC Infect Dis
                BMC Infect. Dis
                BMC Infectious Diseases
                BioMed Central (London )
                1471-2334
                22 July 2019
                22 July 2019
                2019
                : 19
                : 650
                Affiliations
                [1 ]ISNI 0000 0000 8601 0541, GRID grid.412522.2, School of Medicine, , Pontifícia Universidade Católica do Paraná, ; Curitiba, PR Brazil
                [2 ]ISNI 0000 0000 8601 0541, GRID grid.412522.2, Laboratory of Emerging Infectious Diseases, Escola de Medicina, , Pontifícia Universidade Católica do Paraná, ; Rua Imaculada Conceição, 1155, Curitiba, PR 80215-901 Brazil
                [3 ]ISNI 0000 0000 8601 0541, GRID grid.412522.2, Business School, , Pontifícia Universidade Católica do Paraná, ; Curitiba, PR Brazil
                Author information
                http://orcid.org/0000-0003-3471-1786
                Article
                4280
                10.1186/s12879-019-4280-0
                6647098
                31331272
                e189bed7-4b77-4ddf-a73f-fdb32ca1efc2
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 18 December 2018
                : 11 July 2019
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Infectious disease & Microbiology
                antibiotic,oral switch,stewardship,intensive care unit,critically ill patients

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