IDSA: Conversion from IV to Oral Antimicrobials Uncommon

SAN DIEGO, Oct. 10 -- Only 30% of hospitalized patients eligible for conversion from intravenous to oral antimicrobials actually do so, according to results of a study reported here.

Patients who were converted from IV to oral therapy had similar cure rates yet shorter hospital stays and lower hospital costs, compared with patients who stayed on IV therapy, Lisa Parizek, Pharm.D., of the University of Nebraska at Omaha said at the Infectious Diseases Society of America meeting.

The results emerged from the baseline phase of a larger pharmacy-initiated step-down study "These data support the rationale for a step-down conversion program," said Dr. Parizek.

Converting patients from IV to oral therapy is one strategy for reducing the length of hospital stays and minimizing healthcare-associated morbidity, among other goals, said Dr. Parizek.

Misconceptions and institutional barriers may pose obstacles to antimicrobial step-down therapy, she continued. These include:

• The belief that oral therapy is less effective than IV.
• The belief that the oral therapy must be the same agent as the IV therapy.
• Concern that patients will not qualify for inpatient status if converted to oral therapy.
• Uncertainty about therapeutic alternatives.

Dr. Parizek and colleagues evaluated the feasibility and realities of an antimicrobial step-down program on a general medicine hospital unit. Patient eligibility criteria included admission to the medicine unit for more than 24 hours, administration of agents not included in an existing IV-to-oral protocol for at least 48 hours, other oral medications included in the patient's treatment, eating or tolerating enteral feeding, normal vital signs and white cell count.

Of 232 patients initially included in the study, 81 (34.9%) met inclusion criteria for the step-down protocol. Of the eligible patients 22 (30.1%) were actually converted from IV to oral therapy. Patients converted to oral therapy did not differ from those who were not converted in demographic or clinical variables.

Patients converted from IV to oral therapy had a median length of stay of three days compared with five for patients who remained on IV therapy (P=0.005). Duration of IV therapy was a day shorter with conversion (two versus three), but overall duration of antimicrobial therapy was three days in each group.

The median total hospitalization cost was ,770 with step-down therapy and ,093 without (P=0.0025). In the IV cohort, 36 of 51 patients (70.6%) achieved a cure as did 16 of 22 (72.7%) in the step-down group. The rate of IV complications was similar in the two groups, and antimicrobial costs tended to be lower in the step-down group but not significantly so ( versus ).