Frighetto L, Nickoloff D, Martinusen S M, Mamdani F S, Jewesson P J
Vancouver General Hospital, BC, Canada.
Ann Pharmacother. 1992 Nov;26(11):1447-51. doi: 10.1177/106002809202601119.
To assess the impact of an intravenous-to-oral (iv-po) stepdown program on the relative use of oral and parenteral dosage forms of select antimicrobials.
A retrospective review of drug utilization records before and after a trial comparing metronidazole and clindamycin prescribing trends from a 12-month baseline period to a four-year follow-up period.
One thousand-bed Canadian tertiary care referral teaching center.
An authorized iv-po stepdown program was developed to promote the oral route of drug administration. Reminders of iv-po stepdown were produced for metronidazole and clindamycin and these notes were sent to nursing units with the parenteral dosage form. The notes then were attached to the front of the health record to serve as a reminder to prescribers that an equally effective, well-tolerated, and less-expensive oral dosage form was available for use.
A 44 percent relative increase in the use of oral metronidazole and a 79 percent relative increase in the use of oral clindamycin occurred. When acquisition and delivery costs were considered, cumulative cost savings from 1988 to 1991 resulted for metronidazole ($31,920) and clindamycin ($53,880).
This intervention represents a simple yet effective method of promoting a process of stepdown from parenteral to oral antibiotic therapy.
评估静脉给药改为口服给药（iv-po）的递减方案对某些抗菌药物口服和胃肠外剂型相对使用情况的影响。
一项回顾性研究，比较了甲硝唑和克林霉素从12个月基线期到4年随访期的处方趋势，对试验前后的药物使用记录进行回顾。
拥有1000张床位的加拿大三级医疗转诊教学中心。
制定了一项经授权的静脉给药改为口服给药的递减方案，以促进口服给药途径。针对甲硝唑和克林霉素制作了静脉给药改为口服给药的提醒单，并将这些单子随胃肠外剂型一起发送到护理单元。然后将这些单子附在健康记录的前面，以提醒开处方者有同等疗效、耐受性良好且成本较低的口服剂型可供使用。
口服甲硝唑的使用相对增加了44%，口服克林霉素的使用相对增加了79%。考虑到采购和配送成本，1988年至1991年甲硝唑（31920美元）和克林霉素（53880美元）累计节省了成本。
这项干预措施是促进从胃肠外抗生素治疗改为口服抗生素治疗的一种简单而有效的方法。
