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Assessment of Sequential Antibiotics Therapy at UMMC

This study evaluates the effectiveness and cost-savings of sequential antibiotics therapy at University Malaya Medical Centre, focusing on IV-to-oral conversions and associated outcomes.

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Assessment of Sequential Antibiotics Therapy at UMMC

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  1. The Assessment Of Sequential Antibiotics Therapy In University Malaya Medical Centre (UMMC) Che Zuraini Sulaiman Pharmacist UMMC

  2. INTRODUCTION Sequential Antibiotics Therapy • the conversion of intravenous to oral antibiotic treatment using the same medication (Lelekis, et al. 2001) • Pre-set criteria to direct sequential antibiotic therapy vs physician-directed conversion Advantages • Cheaper treatment costs (Lelekis, et al. 2001) • Shortens LOS (Lelekis et al., 2001, Hunter et al., 1995, van der Eerden et al., 2004) • Reduce IV catheter-related complications ((Lelekis, et al. 2001, van der Eerden et al., 2004, Vogel, F, 1995) • Convenient to patients and hospital personnel (Vogel, F, 1995)

  3. AIM & OBJECTIVES AIM • To assess the need to establish a sequential antibiotic therapy program in UMMC OBJECTIVES 1. To identify the current practice of IV-to- oral conversions in UMMC 2. To calculate the potential cost-savings of sequential antibiotic therapy

  4. METHODOLOGY

  5. STUDY DESIGN prospective observational study DURATION OF STUDY Dec 2006 - Feb 2007 STUDY POPULATION all patients admitted to UMMC receiving targeted antibiotics and fulfilling the inclusion criteria CALCULATED SAMPLE SIZE 302 (confidence level 95%, confidence interval 5%, estimated prevalence 0.50)

  6. Targeted Antibiotics Ampicillin Azithromycin Benzypenicillin Clindamycin Cloxacillin Cotrimoxazole Amoxicilin/clavulanic acid Ciprofloxacin Ampicillin/sulbactam Cefuroxime

  7. RESULTS & DISCUSSIONS

  8. MEAN (±SD) DURATION CRITERIA FOR IV TO ORAL CONVERSION WERE MET (N=196)

  9. IV TO ORAL CONVERSION OF ANTIBIOTICS ACCORDING TO SITES OF INFECTION (N=196)

  10. STUDY LIMITATIONS • exclusion of patients receiving targeted antibiotics that were kept as ward stock • inability to perform a detailed cost analysis

  11. CONCLUSION • sequential antibiotic therapy is commonly practised in UMMC • the conversions from IV to oral antibiotics are often delayed • total potential cost savings was estimated to be approximately RM100,000 annually

  12. RECOMMENDATIONS • Establishment of a safe and cost-effective policy of sequential antibiotic therapy in UMMC • Development of a set of criteria for IV to oral conversion with the help of ID team • Implementation of sequential antibiotic therapy program through team approach

  13. Acknowledgement • Ms Ho See Wan1, • Ms Reena Rajasuriar1, • Prof Dr Adeeba A Kamarulzaman2 • 1 Department of Pharmacy, University Malaya • 2 Infectious Disease Unit, University Malaya Medical Centre

  14. REFERENCES

  15. Lelekis, M & Gould, IM 2001, ‘Sequential antibiotic therapy for cost containment in the hospital setting: why not?’, Journal of Hospital Infection, vol. 48, no. 4, pp. 249-257. Retrieved July 25, 2006, from Science Direct database. Shah, PM 2000, ‘Sequential or switch treatment - which criteria should be fulfilled?’, International Journal of Antimicrobial Agents, vol. 16, no. 301, pp. 301-302. Retrieved July 25, 2006, from Science Direct database. Hunter, KA & Dormaier, GK 1995, ‘Pharmacist-managed intravenous to oral step-down program’, Clinical Therapeutics, vol. 17, no. 3, pp. 534-540. Retrieved July 16 2006, from Science Direct database.

  16. 4. van der Eerden, MM, de Graaff, CS, Vlaspolder, C, Bronsveld, V, Jansen, HM & Boersma, WG 2004, ‘Evaluation of an algorithm for switching from IV to PO therapy in clinical practice in patients with community-acquired pneumonia’, Clinical Therapies, vol. 26, no.2,pp. 294-303. • Vogel, F 1995, ‘Sequential therapy in the hospital management of lower respiratory infections’, The American Journal of Medicine, vol. 99, no. supplement 6B, pp. 14S-19S. 6. Barlow, GD & Nathwani, D 2000, ‘Sequential antibiotic therapy’, Current Opinion in Infectious Diseases, vol. 13, no. 6, pp. 599-607.

  17. Thank You

  18. Formula • number of days of delayed conversion=number of days with IV antibiotic−day all criteria of conversion were met • acquisition cost for IV antibiotic=number of days of delayed conversionxbasic units of IV antibiotic given per dayxbasic unit acquisition price of IV antibiotic • acquisition cost for oral antibiotic=number of days of delayed conversionxbasic units of oral antibiotic given per dayxbasic unit acquisition price of oral antibiotic • the potential cost saving of antibiotic acquisition cost=antibiotic acquisition cost for IV antibiotic−antibiotic acquisition cost for oral antibiotic

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