Correlates and Economic and Clinical Outcomes of an Adult IV to PO Antimicrobial Conversion Program at an Academic Medical Center in Midwest United States.

The study objectives were to evaluate the correlates and outcomes of a parenteral (IV) to oral (PO) antimicrobial conversion program at a Midwest US Academic Medical Center with the hypothesis that it will be associated with reduced drug costs. Patient-level data (n = 237; sex, race, admission source, admission status, admission severity, risk of mortality [relative expected, admission], and early death) were extracted from the Clinical Data Base/Resource Manager. Medication-level, drug-encounter data (n = 317; antibiotic/dose/route/frequency/duration, conversion status, 10-day IV/PO switch-eligibility criteria) were extracted from patient's hospital medical records. Univariate analyses using chi-square or Fisher's exact test for categorical variables and Wilcoxon rank-sum test for continuous variables showed patients not converted (n = 149) versus converted (n = 88) at some point from IV to PO were more likely to be of white race and had higher risk of relative expected mortality. By applying the unit drug cost (derived from 2010 Thomson Reuters RED BOOK(TM)) and labor costs for IV/PO administration, both per dose, the overall 1-month drug cost-saving estimates in 2010 in US dollars were US$5242 from converting and US$8805 savings missed from not converting 518 and 1387 switch-eligible antibiotic doses, respectively. Despite sample-size limitations, this study demonstrated correlates and missed opportunities to convert antimicrobials from IV to PO, which warrants providers' attention.

Evaluation of outcomes of intravenous to oral antimicrobial conversion initiatives: a literature review.

Inappropriate use of antimicrobial agents could result in antimicrobial resistance that could impact clinical cure outcomes (by increasing morbidity in terms of increased adverse events and risk of secondary and hospital-acquired infections and mortality) and increase costs to health care institutions. Thus, appropriate antimicrobial use has become vital for balancing patient safety and costs and is therefore a focus for health care institutions. This is often achieved through efforts of antimicrobial stewardship programs that include intravenous to oral conversion initiatives with clinical pharmacists playing an instrumental role in their development and implementation with medical staff approval. However, the delivery and effectiveness of these programs are quite variable. Therefore, for guiding the successful delivery and evaluations of these programs in the future, the objective of this literature review is to document the impact of intravenous to oral conversion programs in terms of clinical and economic outcomes at various institutions worldwide along with the pharmacist's role in these programs.