Antimikrobiyal Tedavide İntravenözden Orale Geçiş Protokolü Geliştirilmesi ve Uygulamasının Geçişe Etkisi ve Klinik Eczacının Rolü

Abstract

In antimicrobial treatment, it is recommended to switch from intravenous to oral therapy in eligible patients to reduce complications and ensure pharmacoeconomic treatment. In this study, we evaluated the effect of a clinical pharmacist-led oral switch protocol, education and recommendations provided to physicians on the switch rates. This study was conducted at Hacettepe University Hospitals between January and June 2024 and consisted of two periods as observation and intervention. Before the start of the study periods, a two-round expert panel was conducted to determine the eligibility and ineligibility criteria for oral switching. During the observation period, intravenous antimicrobial therapies was observed without intervention. During the intervention period, the oral switch protocol was implemented, infectious disease physicians were educated about the oral switch, and physicians were recommended to switch in eligible treatments. The two study periods were evaluated in terms of the rate of switching in eligible treatments. During the study period, 962 intravenous antimicrobial treatments were included. Patients in both study periods were similar in terms of demographic characteristics. During the study period, 213 (22.1%) treatments were considered eligible for switching. The rate of switching to appropriate treatments increased significantly, from 29% in the observation period to 54% in the intervention period (p<0.001). There was no difference in the rates of readmission, C. difficile development and transfer to intensive care unit rate between switched and non-switched antimicrobial treatments among eligible treatments (p>0.05). Implementing interventions to increase intravenous to oral switching in antimicrobial stewardship programs may reduce the duration of intravenous treatment and improve the timing of switching while achieving similar clinical outcomes. Switching interventions by clinical pharmacists may help to increase the oral switch rate and improve antimicrobial utilization.