Journal of Clinical and Diagnostic Research. 2018 Mar, Vol-12(3): FC01-FC04 1 1 DOI: 10.7860/JCDR/2018/31647.11246 Original Article Pharmacology Section Practice of Intravenous to Oral Conversion of Antibiotics and its Influence on Length of Stay at a Tertiary Care Hospital: A Prospective Study INTRODUCTION Infectious diseases are more likely to affect the population all over the world. Hence, antibiotic therapy has become crucial in the effective management of infectious diseases. Antibiotic therapy yield good results when they are administered by IV route. At times, one has to consider the concept of IV to PO conversion of antibiotic therapy. Antibiotics are considered suitable for IV to oral conversion if they have appropriate spectrum, high degree of activity against the presumed or known pathogen, and have good bioavailability. Many patients remain on expensive IV medications, even after they become able to take bioequivalent oral alternatives. Several studies have demonstrated the efficacy and safety of switching from IV to oral antibiotics in clinically stable patients [1,2]. One way of optimising antibiotic use is to switch earlier from IV to oral therapy, with the following advantages: i) benefits to the patient; ii) lower costs and; iii) reduced workload, e.g., reduced incidence of catheter-related infections, a shorter LOHS, a reduction in costs and an associated reduction in workload without sacrificing patient safety [3,4]. Multidisciplinary medical team shall consider the three important factors like proper patient selection, an appropriate therapeutic approach and patient health education for the successful conversion of IV to oral antimicrobial agents [2,5]. Infectious disease specialist shall evaluate the patient and explore the suitability of the patient for IV to oral switch. This eventually may lead to early discharge and reduce cost burden on the patient [6]. Earlier study results report that implementation of pharmacist mediated IV-PO dosage form conversion service found to be more effective in declining the proportion of inappropriate IV doses and associated costs [7]. The IV conversion to PO therapy can reduce length of hospital stay, healthcare costs and risk of complications related to IV access [8,9]. This conversion may be a “switch therapy”, “sequential therapy” or “step-down” therapy. IV to PO switch programs are highly appropriate and more applicable to antibiotics such as fluoroquinolones (levofloxacin, moxifloxacin), tetracyclines (doxycycline, minocycline), macrolides (clindamycin), co-trimoxazole (sulfamethoxazole- trimethoprim), chloramphenicol, linezolid, metronidazole and antifungal drugs such as fluconazole, itraconazole and voriconazole [10]. According to some authorities, approximately 40% of patients starting on IV antibiotics are candidates for a switch to oral antibiotics after 2-3 days of therapy. There are very few studies on the practice of IV to oral switch in clinical settings of Indian population [11]. Hence, present study aimed to evaluate practice of IV to oral conversion of antibiotics and its impact on length of stay in a tertiary care hospital. MATERIALS AND METHODS Study Design and Ethical Aspects A prospective observational study was carried out for a period of six months (November 2015 to April 2016) in Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation at Chinaoutpalli, Gannavaram Mandal, Krishna district, Andhra YANNAMANI SATYA TEJASWINI 1 , SIVA REDDY CHALLA 2 , KRISHNA SRI NALLA 3 , RAJA SREE GADDE 4 , ANNE LAKSHMI PAVANI 5 , VISWANADHAPALLI NEERISHA 6 Keywords: Intravenous to oral switch, Sequential therapy, Step-down therapy ABSTRACT Introduction: Several studies have demonstrated the efficacy and safety of switching from intravenous to oral antibiotics in clinically stable patients. Early switch from Intravenous (IV) to Per Oral (PO) could be one of the factors that influence the Length of Hospital Stay (LOHS). Aim: To evaluate the practice of switch from intravenous to oral antibiotics and its impact on the LOHS at a tertiary care hospital. Materials and Methods: A prospective observational study was conducted over a period of six months from November 2015 to April 2016. The practice of conversion from IV to PO antibiotic therapy was assessed according to predefined criteria for clinical stability. Clinical end points such as day of IV to PO switch, LOHS and duration of antibiotic therapy were assessed. Results: Results reveal that 43.68% of antibiotics were converted from IV to oral formulation while 56.32% of antibiotic courses were not converted from IV to oral. Out of all IV to oral conversions, sequential therapy was more commonly used than switch and step-down therapy. LOHS for patients had significantly (p<0.05) decreased following IV to oral conversion of antibiotics in comparison to LOHS for patients with non conversion of antibiotics from IV to oral formulation. Day of conversion was more delayed in switch therapy than two other modes of conversion. Conclusion: Timely switching of antibiotics from IV to oral therapy could reduce the length of hospitalisation for patients.