Intravenous to oral antimicrobial switch

Prolonged use of intravenous (IV) antimicrobial therapy to treat severe infections is common. Unnecessary prolonged use can lead to patient harm, increased risk of antimicrobial resistance and healthcare associated costs.

Best practice recommendations suggest having a process to flag safe early IV to oral switch for antimicrobials. ¹ Studies show that switching to oral antimicrobials earlier does not compromise patient care.

The project team developed and implemented a clinical decision support tool to triage prescribed IV antimicrobial orders for a post-prescription review. The Antimicrobial Stewardship (AMS) team and pharmacists are alerted to these orders when a patient meets the algorithm, pre-defined by the Clinical Applications Advisory Group for Antimicrobial Stewardship. The indications list only included respiratory, intraabdominal, and urological infections. The project team also completed a life cycle analysis for IV antimicrobials and consumables, to demonstrate the carbon emissions savings.

There was good clinician uptake, with a 1.7-fold increase in accepting AMS recommendations to switch IV to oral, when compared to 2022. When an appropriate IV to oral switch occurred, there was a reduced length of stay (LOS). Admissions for severe community acquired pneumonia in the intervention group had an average LOS of 13.7 days, and the control group had a LOS of 17.4 days. The carbon emissions savings for IV antimicrobials range from 0.10-1.94kgCO₂e per unit of IV antibiotic.

If replicated, the project should be led by the Antimicrobial Stewardship Committee at the respective local health district, as the committee will need to adapt the tool to fit into their antimicrobial stewardship program and workflows.

References