Switching From I.V. to Oral Antimicrobial Therapy
There is increasing pressure from managed care organizations to discharge patients from the hospital to the ambulatory care setting as early as possible. One strategy for speeding discharge is to switch patients from intravenous to oral drug therapy when possible. This reduces drug costs without compromising patient outcomes, lowers the risk of catheter-related infectious complications, and improves patient satisfaction.

Given that antimicrobial agents account for a substantial portion of the drug budget and that there are many safe and effective oral antimicrobial agents, institutions have identified specific antimicrobials for switching from i.v. to oral administration. Terms such as switching, conversion, step-down therapy, sequential therapy, and streamlined therapy have all been used in the literature to describe the change from the i.v. to oral route. Several reports of pharmacist-initiated conversion programs have briefly described how the programs were implemented, such as with chart reminders or by telephoning prescribers about patients who meet the criteria for switching. However, most reports have not provided a detailed description of the implementation process or the barriers to implementation.

This report describes a step-by-step process by which we implemented a pharmacist-initiated, automatic, i.v.-to-oral antimicrobial switching program.