Unnecessary IV Antibiotic Days Using General Criteria for Antibiotic Switch

Observation of the use of intravenous antibiotics in medical clinic of Sorlandet Hospital, Norway. Suggestions of criteria for the switch from intravenous to oral administration of antibiotics. Implementation of the criteria and new registration of the use of intravenous antibiotics. Comparison of the amount of the iv-administration before and after the intervention.

Study Overview

• Status: Completed
• Conditions: Infection
• Intervention / Treatment: Other: Implementation of antibiotic switch guidelines

Detailed Description

The study is a comparison of the use of intravenous antibiotics before and after the implementation of switch criteria. Switch is defined as a change in administration route from intravenous to oral.

Patients administered to medical department at Sorlandet hospital in Kristiansand and Arendal are included if they are receiving intravenous antibiotics. Pediatric department is not included. Patients that are already hospitalized and given intravenous antibiotics are also included.

Patients that are excluded are those with CNS-infection, endocarditis, bone/joint infection, deep undrainable abscesses and those with foreign body infection.

Switch criteria are made from a thorough investigation on earlier switch studies. We have collected several studies on this topic, but none from the nordic countries.

The intervention contributes the following: The implementation of a registration form where doctors are prone to answer six questions when they evaluate antibiotic administration form.

1. Are there special iv-indications? (CNS-infection, endocarditis, bone/joint infection, deep undrainable abscesses or foreign body infection)
2. Is the oral route compromized? (unconscious, nausea, vomiting, diarrhoea, dysphagia, lack of cooperativeness)
3. Is the patients suffering from immunosuppression? (leukopenia, cytotoxic treatment, transplantation, steroids >10mg, TNF-alfa inhibitor treatment, unregulated diabetes mellitus (HbA1C >10), uremia (serum-creatinine > 300), HIV, AIDS, lymphoma, multiple myelomas, cystic fibrosis, asplenic)
4. Is the systemic inflammatory response syndrome present?
5. Is the preferred antibiotics only available in intravenous form?
6. Are there any other special reasons for intravenous antibiotics?

If the doctor can answer NO to all these questions, then the patient is a candidate for antibiotic switch from day three after hospitalization. This evaluation form follows the other medical registration forms from day to day.

The intervention also includes

• A lecture by the study group to all our medical doctors.
• Information by e-mail to all our medical doctors
• Information by letters to all our medical doctors and chief nurses

Registration of parameters used for evaluating antibiotic switch is done three times a week by the study group. We register date and patient information, if other medication is taken orally, heart rate, respiratory rate, temperature, biochemical parameters (CRP and leukocytes), diagnosis and antibiotic choice.

• Study Type: Observational
• Enrollment (Actual): 187

Contacts and Locations

Study Locations

• Norway
  • Aust-Agder
    • Arendal, Aust-Agder, Norway, 4500
      • Sorlandet Sykehus Arendal
  • Vest Agder
    • Kristiansand, Vest Agder, Norway, 4604
      • Sørlandet Sykehus Kristiansand

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 15 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Alle patients with suspected infection and who is gives intravenous antibiotics

Exclusion Criteria:

• CNS-infection
• Endocarditis
• Bone/joint infection
• Undrained abscess
• Foreign body infection
• Compromized oral route
• Immunosuppression
• Patients meeting the systemic inflammatory response syndrome criteria
• No preferred oral antibiotic available
• Other conditions requiring intravenous administration

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
1; Observation group
2; Intervention group	Other: Implementation of antibiotic switch guidelines; Implementation of antibiotic switch guidelines; Other Names: Antibiotic switch

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Reduction in the amount of intravenous antibiotic days	During stay

Secondary Outcome Measures

Outcome Measure	Time Frame
Hospital stay duration, re-admittance, re-prescription of intravenous antibiotic therapy	4 weeks

Collaborators and Investigators

• Sponsor: Sorlandet Hospital HF
• Investigators: Principal Investigator: Bjoern Waagsboe, Ass dr, Medical department Kristiansand; Study Director: Anders Sundoy, Chief Doc, Medical dep kristiansand; Study Director: Else Quist Paulsen, ass doc, Med dep Arendal

Study record dates

Study Major Dates

• Study Start: November 1, 2006
• Primary Completion (Actual): January 1, 2007
• Study Completion (Actual): March 1, 2007

Study Registration Dates

• First Submitted: August 16, 2007
• First Submitted That Met QC Criteria: September 29, 2008
• First Posted (Estimate): September 30, 2008

Study Record Updates

• Last Update Posted (Estimate): September 30, 2008
• Last Update Submitted That Met QC Criteria: September 29, 2008
• Last Verified: September 1, 2008

More Information

Terms related to this study

• Keywords: Urinary tract infection; Soft tissue infection; Lower respiratory infection; Upper respiratory infection; Hepatobiliary infection
• Additional Relevant MeSH Terms: Infections; Anti-Infective Agents; Antitubercular Agents; Anti-Bacterial Agents; Antibiotics, Antitubercular
• Other Study ID Numbers: Antibiotic Switch