CURRENT PRACTICE OF INTRAVENOUS TO ORAL CONVERSION OF ANTIBIOTICS AT A TERTIARY CARE HOSPITAL: A PROSPECTIVE STUDY

Dr. Sneha Sebastian*, Dr. Priya Saji Koliyakodu, Dr. Sherine Justin, Gayatri P. Sapkale, Dr. Vishnu V. K.

ABSTRACT

Introduction: The patients admitted in general ward of a hospital with severe infections who adequately absorb oral medication and initially require IV therapy can be safely switched to oral therapy within 2-3 days. There are number of advantages like fewer complications and decreased length of hospital stay (LOHS). Aim: To evaluate the practice of switching from IV to oral antibiotics, identification of IV complications in non-converted patients, case related barriers to an early switch and thereby influence in LOHS. Materials and Methods: A prospective observational study was conducted over a period of 3 months from March-May 2019. NUH guidelines were used to evaluate the early switch based on clinical stability. Clinical based end points such as complications, barriers for conversion, duration of antibiotics and LOHS were assessed. Results: The study reveals that among antibiotic courses, 51% and 49% were converted and non-converted respectively. Sequential conversion therapy was more commonly used than switch and step-down therapy. IV complications (49%) were identified in non-converted patients, pain (57.1%) followed by phlebitis (36.7%) and extravasation (6.12%). By means of case-specific interviews, barriers (49%) were identified for conversions. The most frequently mentioned barriers were “supervisor’s opinion” in 9 (18.3%) cases followed by different patient factors. Duration of IV therapy and LOHS for patient population had significantly (p<0.05) decreased following IV to PO conversions compared to non-conversion therapy. Conclusion: Switching of antibiotics based on predefined criteria for clinical stability lead to decreased rate of complication from IV lines and thereby decreased LOHS.

Keywords: IV to PO conversions, switch therapy, sequential therapy, step-down therapy.