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Pharmacy World and Science

, Volume 24, Issue 6, pp 247–255 | Cite as

Intravenous and oral antibiotics in respiratory tract infection: an international observational study of hospital practice

  • J. CookeEmail author
  • T. Morris
  • M. Kubin
  • J. Ribas
  • I. Krämer
  • I. Kämmerer
  • R. Fornani
  • A.‐C. Ballet
  • P.‐P. Sagnier
Article

Abstract

Background: Hospitalised patients with respiratory tract infections (RTI) frequently receive intravenous %lpar;IV) antibiotics followed by a short course of oral treatment.Objectives: To observe antibiotic use in hospitals in Germany, Spain, France, Italy and the UK and the reasons for choosing the IV route and switching to oral treatment. Methods: Research pharmacists sought the opinions of physicians and senior nurses in the completion of a semi-structured questionnaire on the treatment of RTI with IV antibiotics. Questions focussed on antimicrobials of choice, reasons for choosing IV, reasons for changing to oral administration, and duration of treatment.Results: This study recruited 796 patients with RTI, usually pneumonia. Prescribing patterns varied widely between the five hospitals. Accepted clinical criteria were only commonly cited in Germany, Spain and the UK as reasons for choosing the IV route at the beginning of the study. These were more commonly cited at the time of switch, although other criteria such as improved condition, were other significant reasons. The mean duration of IV treatment ranged from 4 days in the UK to 10 days in Italy, where most patients received the full course of treatment by the IV route. Unlike the other hospitals studied, the few patients in Italy who were switched to another form of treatment were as likely to receive intramuscular as oral administration (13% and 11%, respectively). Conclusions: The practice of and reasons for prescribing IV antibiotics varied in the hospitals studied. Objective clinical criteria were inconsistently cited as reasons for administering IV antibiotics and in general these reasons were unrelated to those given for the switch from IV to oral administration. In order for guidelines for switching from IV to oral antimicrobials to be routinely employed, explicit physiological criteria need to be recorded in a routine fashion. Closer co‐operation between pharmacists and physicians may help in developing and implementing guidelines at a local level.

Antibiotics Hospital pharmacy Intravenous antibiotics Observational study Oral antibiotics Respiratory tract infection Switch therapy 

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References

  1. 1.
    Mandell LA et al. Sequential antibiotic therapy: effective cost management and patient care. Can J Infect Diseases 1995;6:306-15.Google Scholar
  2. 2.
    Ramirez JA et al. Early switch from intravenous to oral cephalosporin in the treatment of hospitalized patients with community-acquired pneumonia. Arch Intern Med 1995;155:1273-6.Google Scholar
  3. 3.
    Frighetto L et al. Intravenous to oral stepdown program: four years of experience in a large teaching hospital. Ann Pharmacother 1992;26:1477-51.Google Scholar
  4. 4.
    Louie TJ. Intravenous to oral stepdown antibiotic therapy: another cost-effective strategy in an era of shrinking health care dollars. Can J Infect Diseases 1994; 5(Suppl C):45C-50C.Google Scholar
  5. 5.
    Parker SE, Davey PG. Pharmacoeconomics of intravenous drug administration. PharmacoEconomics1992;1:103-15.Google Scholar
  6. 6.
    Francombe P. Intravenous filters and phlebitis. Nursing Times 1988;84: p. 34-5.Google Scholar
  7. 7.
    Ramirez JA et al. Early switch from intravenous to oral antibiotics and early hospital discharge. Arch Intern Med 1999;159:2449-54.Google Scholar
  8. 8.
    Ikeda A, Nishimura K, Izumi T. Pharmacological treatment in acute exacerbations of chronic obstructive pulmonary disease. Drugs Aging 1998;12:129-37.Google Scholar
  9. 9.
    Lorenz J. Comparison of 5-day and 10-day cefixime in the treatment of acute exacerbation of chronic bronchitis. Chemotherapy 1998;44:(Suppl 1):15-8.Google Scholar
  10. 10.
    DeAbate CA et al. Effectiveness of short course therapy (5 days) with grepafloxacin in the treatment of acute bacterial exacerbations of chronic bronchitis. Clin Ther 1999;21:172-88.Google Scholar
  11. 11.
    Ramirez JA. Advances in antibiotic use: switch therapy. Curr Ther Res Clin Exp 1994;55(suppl A):30-4.Google Scholar
  12. 12.
    Allen B. A campaign to improve the timing of conversion from intravenous to oral administration of antibiotics. Aust J Hosp Pharm 1992;22:434-9.Google Scholar
  13. 13.
    Laing RBS et al. The effect of intravenous-to-oral switch guidelines in the use of parenteral antimicrobials in medical wards. J Antimicrob Chemother 1998;42: 107-11.Google Scholar
  14. 14.
    Al-Eidan FA et al. Use of a treatment protocol in the management of community acquired lower respiratory tract infection. J Antimicrob Chemother 2000; 45:387-94.Google Scholar
  15. 15.
    Halls GA. The management of infections and antibiotic therapy: a European survey. J Antimicrob Chemother 1993;31: 985-1000.Google Scholar
  16. 16.
    Vogel F. Sequential therapy in the hospital management of lower respiratory infections. Am J Med 1995; 99(Suppl 6B): 14S-19S.Google Scholar
  17. 17.
    Zamin MT. Pitre MM, Conly JM. Development of an intravenous-to-oral route conversion program for antimicrobial therapy at a Canadian tertiary care health facility. Ann Pharmacother 1997;31:564-70.Google Scholar
  18. 18.
    Cunha BA. Community-acquired pneumonia. Cost-effective antimicrobial therapy. Postgraduate Med 1996;99:109-19.Google Scholar
  19. 19.
    Ahkee S et al. Early switch from intravenous to oral antibiotics in hospitalized patients with infections: a 6-month prospective study. Pharmacotherapy 1997;17:569-75.Google Scholar
  20. 20.
    Jensen KM, Paladino JA. Cost-effectiveness of abbreviating the duration of IV antibacterial therapy with oral fluoroquinolones. Pharmacoeconomics 1997;11:64-74.Google Scholar
  21. 21.
    Janknegt R, van der Meer JWM. Antimicrobial practice. Sequential therapy with intravenous and oral cephalosporins. J Antimicrob Chemother 1994;33:169-77.Google Scholar
  22. 22.
    Sevinc F et al. Early switch from intravenous to oral antibiotics: guidelines and implementation in a large teaching hospital. J Antimicrob Chemother 1999;43:601-6.Google Scholar

Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • J. Cooke
    • 1
    Email author
  • T. Morris
    • 1
  • M. Kubin
    • 2
  • J. Ribas
    • 3
  • I. Krämer
    • 4
  • I. Kämmerer
    • 5
  • R. Fornani
    • 6
  • A.‐C. Ballet
    • 7
  • P.‐P. Sagnier
    • 8
  1. 1.South Manchester University Hospitals NHS TrustWithington HospitalManchesterUK
  2. 2.Health Economics and Outcomes ResearchBayer VitalLeverkusenGermany
  3. 3.Hospital Clinic I ProvincialBarcelonaSpain
  4. 4.Johannes-Gutenberg UniverstätMainzGermany
  5. 5.Dr Horst Schmidt KlinikenWiesbadenGermany
  6. 6.Ospedale CareggiFlorenceItaly
  7. 7.Centre Hospitalier Universitaire de BordeauxFrance
  8. 8.Health Economics and Outcomes ResearchBayer plcSloughUK

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