von Gunten Vera, Amos Viviane, Sidler Anne-Laure, Beney Johnny, Troillet Nicolas, Reymond Jean-Philippe
Divisions of Pharmacy and Infectious Diseases, Central Institute of the Valais Hospitals, 86, Ave. Grand-Champsec, 1950, Sjon, Switzerland.
Pharm World Sci. 2003 Apr;25(2):52-5. doi: 10.1023/a:1023240829761.
The cost of antibiotics in hospitals may be reduced by streamlining, and, particularly, by early switching from the intravenous (i.v.) to the oral route of administration. The aim of the study was to evaluate the feasibility and impact of guidelines for switching, reinforced by pharmacists.
Patients admitted to internal medicine wards and treated with i.v. antibiotics for various infections were included for six weeks before (group A) and six weeks after (group B) the intervention. Differences in patient characteristics and their outcomes were sought between the two groups.
The 26 patients in group B stayed longer in hospital than the 29 in group A (13.3 vs. 9.7 days; P = 0.05). They also tended to need more time to reach the pre-defined criteria for switching (3.6 vs. 2.4 days; P = 0.09). From that point on, they were switched more rapidly to oral antibiotics (1.5 vs. 3.2 days; P = 0.02), which resulted in a trend toward a lower treatment cost until their discharge (44 vs. 92 euros; P = 0.08). No difference was found between the 2 groups for the duration of the i.v. therapy, or the total in-hospital cost of antibiotics.
Pharmacists may help implement and reinforce guidelines for switching to oral antibiotics. The evaluation of such interventions implies the choice of appropriate outcomes and the awareness of confounding factors.
通过优化流程，特别是通过早期从静脉给药途径转换为口服给药途径，可降低医院抗生素成本。本研究的目的是评估由药剂师强化的转换指南的可行性和影响。
纳入内科病房因各种感染接受静脉抗生素治疗的患者，在干预前6周（A组）和干预后6周（B组）进行观察。比较两组患者特征及其结局的差异。
B组的26例患者住院时间比A组的29例患者长（13.3天对9.7天；P = 0.05）。他们达到预先定义的转换标准也往往需要更多时间（3.6天对2.4天；P = 0.09）。从那时起，他们更快地转换为口服抗生素（1.5天对3.2天；P = 0.02），这导致出院前治疗成本有降低趋势（44欧元对92欧元；P = 0.08）。两组在静脉治疗持续时间或抗生素住院总费用方面未发现差异。
药剂师可能有助于实施和强化转换为口服抗生素的指南。对此类干预措施的评估意味着要选择合适的结局指标并意识到混杂因素。
