[Preventing prolonged antibiotic therapy by active implementation of switch guidelines].

OBJECTIVE: To reduce the number of days of unnecessary intravenous antibiotic therapy via an early switch to oral antibiotic therapy.

DESIGN: Prospective, open trial.

METHODS: A guideline was drawn up for an early and yet safe switch from intravenous to oral antibiotic therapy. Patients on the wards of Internal Medicine, Pulmonology, Surgery and Orthopaedics of the Haaglanden Medical Centre in The Hague, the Netherlands, were followed for four months. A zero measurement at two months was followed by an intervention period of two months. The number of unnecessary days of intravenous antibiotic therapy was taken as the measure of effectiveness. A multidisciplinary team carried out the interventions, consisting of educational, supportive and guiding measures. Making progress measurable and giving feedback played an important role during the intervention.

RESULTS: During the zero-measurement period on the Internal Medicine and Pulmonology wards, 26% (9/35) of patients were switched within the timeframe predefined by the guideline. The average number of unnecessary i.v. days was 2.4 (median: 2). During the intervention period, 84% (64/76) were switched within the predefined timeframe, with an average of 0.2 unnecessary i.v. days per patient (median: 0). There was thus a significantly lower number of unnecessary i.v. days after intervention (difference: 2.2; 95%-CI: 1.5-3.0). On the surgical and orthopaedic wards, 9% (2/22) of patients were switched within the predefined timeframe during the zero-measurement period, with an average of 7.3 unnecessary i.v. days (median: 5). During the intervention period, 52% of patients (17/33) were switched within the predefined timeframe, for an average of 1.1 unnecessary i.v. days (median: 0). The reduction in the number of unnecessary i.v. days was also significant here (difference: 6.2; 95%-CI: 2.9-9.5).

CONCLUSION: A significant reduction in the number of unnecessary days of intravenous antibiotic therapy was obtained via simple interventions carried out by a multidisciplinary team.