Intravenous to Oral Conversion of Antibiotics Practice in Multidisciplinary Wards in Hospital Baling

Abstract

Introduction:
The conversion of intravenous (IV) antibiotics to effective oral (PO) formulations is a crucial element promoted in Antimicrobial Stewardship Program (ASP) activities. Early conversion practices offer numerous benefits, including fewer complications, reduced healthcare costs, and shorter length of hospital stay (LOS). This study aimed to determine the prevalence of switching from IV to PO antibiotics following criteria outlined in the IV-to-PO Antibiotic Switch Therapy Protocol, assess the duration of IV antibiotic administered and LOS, and assess the type of IV-to-PO conversion therapy being practiced.
Methods:
A cross-sectional study involving adult patients who received IV antibiotics from January to December 2021 in Hospital Baling, Kedah was conducted. Medical records of all patients who met the predetermined inclusion were reviewed.
Results:
Among 455 patients, approximately two-thirds (74.7%) were eligible for early conversion, yet only 48.5% of patients underwent timely conversion. Early conversion was statistically significant for pneumonia (P<0.001) and urinary tract infections (P=0.002). Amoxycillin-Clavulanate and Cefuroxime showed statistically significant differences in conversion practices (P<0.001). A shorter duration of IV therapy (3.06 ± 0.77 days) and LOS (4.29 ± 1.64 days) were observed in converted patients compared to non-converted patients (6.11 ± 1.29 days, 7.63 ± 2.78 days, respectively; P<0.001). Patients without COVID-19 showed a higher propensity for conversion therapy (OR=3.37, 95% Cl 2.00–5.65). Sequential conversion therapy was predominantly employed (72.9%).
Conclusion:
A substantial number of eligible patients were not converted, despite the demonstrated benefits of conversion therapy in facilitating earlier discharge. Notably, the switch rate in pneumonia cases remained low, despite the significance of conversion practices. The conversion of Ceftriaxone achieved the lowest switch rate, warranting further attention. These findings underscore the need to strengthen conversion practices within ASP activities.