Background Some of the commonly used anti-infective drugs have excellent oral (PO) bioavailability. The switch from the intravenous (IV) to the PO route, when it is possible, is one of the antimicrobial stewardship recommendations in order to decrease IV complications and nursing workload.

Purpose

1. To determine the percentage of patients who meet criteria for a switch from the IV to the PO route.

2. To evaluate the acceptance of physicians to the switching recommendations of pharmacists.

Material and methods A prospective observational study was conducted among all adult patients admitted to our hospital from August to September 2015 who received an IV antibiotic with oral bioavailability >75% for a period time of 48–72 h.

Available antimicrobial therapy guidelines were reviewed to establish criteria for switching antibiotics from the IV to the PO route. Switching criteria in this study were: (i) acceptable oral tolerance, (ii) haemodynamic stability, iii) clinical improvement (24 h afebrile, leucocytes <15 000 cells/mL), (iv) absence of meningitis, endocarditis or endophtalmitis and (v) not being admitted to the intensive care unit.

The switch was proposed by an electronic prescription advice in those patients who fulfilled all of the criteria.

Results 67 patients were included and 42% (n = 28) fulfilled the switching criteria.

Mean age±SD was 59 ± 6 years (64% males). Prescribed antibiotics were mostly amoxicillin 57% (n = 16) followed by ciprofloxacin 14% (n = 4), levofloxacin 11% (n = 3), metronidazole 11% (n = 3) and clindamycin 7% (n = 2).

The proposed IV to PO switch was accepted in 71% (n = 20) of prescriptions and in 12 of them the change was done during the first 24 h after the pharmacist recommendation.

Justified reasons for non-acceptance were haemodynamic deterioration after the recommendation (n = 1) and complications due to comorbidities (n = 2). Keeping IV treatment until hospital discharge (n = 3) and fulfilling the whole treatment intravenously (n = 2) were classified as non-justified reasons.

Conclusion 42% of patients met the criteria for a switch of the antibiotic administration route. The proposed IV to PO switch was accepted in a relevant number of prescriptions and most were changed during the first 24 h.

No conflict of interest.