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Study finds conversion from IV to oral antibiotics should be prioritized
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A recent study determined that hospitals should prioritize IV to oral conversion programs for antibiotics with high oral bioavailability, or HOB, as potential high-impact targets for antimicrobial stewardship.
“National guidelines recommend that hospitals develop interventions that encourage transition from IV to oral antibiotics,” Michael J. Smith, MD, MSCE, medical director of pediatric antimicrobial stewardship at Duke University Medical Center, told Infectious Diseases in Children. “This practice is more common in adults; our study was designed to describe the landscape of oral use of antibiotics in a cohort of children admitted to freestanding children’s hospitals who were receiving antibiotics with high oral bioavailability and were taking other oral medications.”
Smith and colleagues collected 2015 data from the Pediatric Health Information System, a database maintained by the Children’s Hospital Association. Specifically, the researchers used data from 48 freestanding children’s hospitals and included patients in the study if they were potentially eligible for IV switch. Patients were defined as eligible if they were given an HOB antibiotic, received one or more nonantibiotic oral medications on the same day as the antibiotic and stayed at the hospital for more than 2 days. Antibiotic costs were estimated based on institution-specific cost-to-charge ratios.
During the course of the study, 38,933 children received 221,535 days of therapy (DOT) of HOB antibiotics along with at least one nonantibiotic oral medication. Institutions’ rate of HOB DOT administration ranged from 21.3% to 63.8%, or 35.8% overall. The total hospital cost for all HOB antibiotics administered during the study period was $11,662,963. The estimated cost if all doses had been administered orally was $5,891,137.
“We know from national guidelines and prior studies that it is safe to switch from IV to oral antibiotics in clinically stable children. Our study suggests that this practice is not common in freestanding children’s hospitals. Hospitals should target interventions to increase IV to [oral] switch in children,” said Smith. – by Erin Michael
Disclosure: Smith reports no relevant financial disclosures.
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