Béïque Lizanne, Zvonar Rosemary
BPharm, PharmD, is a Clinical Pharmacy Specialist for the Antimicrobial Stewardship Program, Pharmacy Department, The Ottawa Hospital, and a Clinical Investigator with the Ottawa Hospital Research Institute, Ottawa, Ontario.
BScPhm, ACPR, FCSHP, is currently Antimicrobial Stewardship Program Lead with Public Health Ontario (on leave from her position as Antimicrobial Pharmacy Specialist with the Pharmacy Department, The Ottawa Hospital, Ottawa, Ontario.).
Can J Hosp Pharm. 2015 Jul-Aug;68(4):318-26. doi: 10.4212/cjhp.v68i4.1472.
Many health care institutions are in the process of establishing antimicrobial stewardship programs. Changing the route of administration of antimicrobial agents from intravenous to oral (IV to PO) is a simple, well-recognized intervention that is often part of an antimicrobial stewardship program. However, the attending health care team may have concerns about making this switch.
To provide insights into common concerns related to IV to PO conversion, with the aim of helping antimicrobial stewardship teams to address them.
Published clinical trials and reviews were identified from a literature search of Ovid MEDLINE with the keywords (step down or switch or conversion or transition or sequential) and (antibiotics or antibacterial agents or antimicrobial or anti-infective agents).
The following issues are addressed in this review: benefits of the oral route, serum concentrations yielded by the oral formulation, source of pharmacokinetic data, clinical outcomes, provision of care in the intensive care unit, fear of therapeutic failure, and administration of antimicrobials via feeding tube.
When considering a change to oral therapy, it is important to have a thorough understanding of key aspects of the antimicrobial agent, the patient, and the disease being treated. The antimicrobial stewardship team has an important role in facilitating IV to PO conversion, educating prescribers, and addressing any concerns or reservations that may interfere with timely transition from IV to PO administration.
许多医疗机构正在建立抗菌药物管理计划。将抗菌药物的给药途径从静脉注射改为口服（从静脉注射改为口服）是一种简单且广为人知的干预措施，通常是抗菌药物管理计划的一部分。然而，主治医疗团队可能对进行这种转换存在担忧。
深入了解与从静脉注射改为口服相关的常见担忧，以帮助抗菌药物管理团队解决这些问题。
通过对Ovid MEDLINE进行文献检索，使用关键词（逐步降级或转换或转变或过渡或序贯）和（抗生素或抗菌剂或抗菌药物或抗感染药物）确定已发表的临床试验和综述。
本综述讨论了以下问题：口服途径的益处、口服制剂产生的血清浓度、药代动力学数据的来源、临床结果、重症监护病房的护理提供、对治疗失败的担忧以及通过鼻饲管给予抗菌药物。
在考虑改为口服治疗时，全面了解抗菌药物、患者和所治疗疾病的关键方面非常重要。抗菌药物管理团队在促进从静脉注射改为口服、教育开处方者以及解决可能干扰从静脉注射及时转换为口服给药的任何担忧或疑虑方面发挥着重要作用。
