Early switch from intravenous to oral antibiotics:: guidelines and implementation in a large teaching hospital
Early switch from intravenous to oral antibiotics:: guidelines and implementation in a large teaching hospital
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DOI：
10.1093/jac/43.4.601
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发表时间：
1999-04-01
影响因子：
5.2
通讯作者：
Speelman, P
中科院分区：
文献类型：
--
作者：
Sevinç, F;Prins, JM;Speelman, P
近年来提倡“转换疗法”：短期静脉注射抗生素治疗2 - 3天，然后在剩余时间内口服治疗。关于可以从早期转换治疗中受益的患者数量以及在日常实践中引入这种策略的后果知之甚少。我们前瞻性地登记了在引入转换治疗指南之前（n = 362，发明阶段）和之后（n = 281，实施阶段）2个月内内科、外科和肺病科病房的所有抗生素课程。在开始静脉注射抗生素的所有患者中，大约40%是早期静脉注射-口服转换的候选人。在调查阶段，54%（52/97）的合格患者在中位6天（范围2 - 28天）后转为口服治疗。实施指南后，这一百分比上升至83%（66/80）（差异29%，95%CI 16 - 42%; P <0.001）。治疗转换也较早，中位时间为4天（范围为2至16天）。在完成口腔疗程后的6周内，未发生感染复发或因再感染而再次住院。与发明阶段相比，可以避免43%的静脉给药，即每年> 6000次。这意味着每年可能减少60 000荷兰盾（c）。30，000美元）的行政费用。抗生素采购成本的潜在节省为每年54，000荷兰盾（27，000美元）。总之，大量开始静脉注射抗生素的患者是早期静脉注射-口服转换的候选者。该指南被医生广泛接受，并节省了大量的成本和护理时间。
In recent years 'switch therapy' has been advocated: short intravenous antibiotic therapy, for 2-3 days, followed by oral treatment for the remainder of the course. Little is known about the number of patients that could benefit from early switch therapy and the consequences of introducing this strategy in everyday practice. We prospectively registered all antibiotic courses on wards for Internal Medicine, Surgery, and Pulmonology during a 2 month period, before (n = 362, inventorial phase) and after (n = 281, implementation phase) the introduction of guidelines for switching therapy. Approximately 40% of all patients who started on iv antibiotics were candidates for an early iv-oral switch. During the inventorial phase, 54% (52/97) of eligible patients were switched to oral treatment, after a median of 6 days (range 2-28 days). After implementation of the guidelines, this percentage rose to 83% (66/80) (difference 29%, 95% CI 16-42%; P < 0.001). Therapy was also switched earlier, after a median of 4 days (range 2 to 16 days). In the 6 weeks after completion of the oral course, recurrence of infections, or readmissions due to reinfections did not occur. Compared with the inventorial phase, 43% of iv administrations could be avoided, that is >6000 per year. This means a potential annual reduction of dfl.60,000 (c. US$30,000) of administration costs. The potential savings in purchase costs of the antibiotics were dfl.54,000 (US$27,000) annually. In conclusion, a substantial number of patients starting on iv antibiotics were candidates for an early iv-oral switch. The guidelines were well accepted by the physicians and substantial savings in costs and nursing time were achieved.