• Rengganis Pranandari Department of Clinical Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, Indonesia.
  • Sudibyo Supardi Centre of Public Health Intervention Technology, Agency for Health Research and Development, Ministry of Health, Indonesia.
  • Retnosari Andrajati Department of Clinical Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, Indonesia.



Switching antibiotics, Length of stay, Cost


Objective: The prolonged use of intravenous antibiotics might increase the length and cost of hospitalization. The research objective, therefore, was to
evaluate the effect of switching antibiotics on the length of hospital stay and hospitalization cost. The prospective cohort research design was adopted.
The inclusion criteria were in patients who had received intravenous antibiotics.
Methods: The sample comprised 39 patients who switched antibiotics as an exposed group and 39 patients who did not switch as an unexposed
group. The data were collected using the patient medical records and the financial data from the hospital information system. The Mann–Whitney test
and Chi-square or Fisher's exact test was applied in the analysis.
Results: The results revealed that the antibiotics most commonly switched were intravenous ceftriaxone (83.3%) and oral cefixime (94.8%). From the
five switching patterns observed, the most common switch was from intravenous ceftriaxone to oral cefixime in patients with acute gastroenteritis.
All antibiotics were administered in accordance with the National Formulary (NF) guidelines. Only metronidazole (5 mg/ml dose) was inconsistent
with NF. Switching antibiotics did not impact the length of hospital stay and hospitalization cost; however, comorbidities did have an influence here.
Conclusions: Further, switching antibiotics impacted the duration over which intravenous antibiotics were administered and the cost of antibiotics.


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Peraturan Menteri Kesehatan RI No. 2406/Menkes/Per/XII/2011.

Tentang Pedoman Umum Penggunaan Antibiotik.

Hadinegoro SR, Tumbelaka AR, Satari HI. Pengobatan cefixime pada

demam tifoid anak. Sari Pediatr 2001;2(4):182-7.

Abasaeed AE, Vlcek J, Abuelkhair MA, Andrajati R, Elnour AA.

A comparative study between prescribed and over-the-counter

antibiotics. Saudi Med J 2013;34(10):1048-54.

Oosterheert JJ, Bonten MJ, Schneider MM, Buskens E, Lammers JW,

Hustinx WM, et al. Effectiveness of early switch from intravenous to

oral antibiotics in severe community acquired pneumonia: Multicentre

randomised trial. BMJ 2006;333(7580):1193.

McLaughlin CM, Bodasing N, Boyter AC, Fenelon C, Fox JG,

Seaton RA. Pharmacy-implemented guidelines on switching

from intravenous to oral antibiotics: An intervention study. QJM


Shrayteh ZM, Rahal MK, Malaeb DN. Practice of switch from

intravenous to oral antibiotics. Springerplus 2014;3:717.

Ho BP, Lau TT, Balen RM, Naumann TL, Jewesson PJ. The impact of a

pharmacist-managed dosage form conversion service on ciprofloxacin

usage at a major Canadian teaching hospital: A pre-and post-intervention

study. BMC Health Serv Res 2005;5:48.

Rhew DC, Tu GS, Ofman J, Henning JM, Richards MS, Weingarten SR.

Table 7: The effect of confounding variables on the length of

hospitalization and cost of treatment

Variables n Mean Standard



Length of

hospitalization (days)


Adult 65 5.69~6 2.24 0.591

Elderly 13 5.92~6 2.18


Underweight 11 5.91~6 2.62 0.907

Not underweight 67 5.70~6 2.17


Present 69 6.01~6 2.19 0.000

None 9 3.56~4 0.73

Payment methods

Assurance 63 5.95~6 2.29 0.052

Non‑assurance 15 4.80~5 1.66

Cost (rupiah)


Adult 65 2621.780 1849.116 0.433

Elderly 13 2832.572 1408.100


Underweight 11 2806.242 1621.443 0.651

Not underweight 67 2632.396 1811.281


Present 69 2874.471 1774.747 0.000

None 9 988.959 278.168

Payment methods

Assurance 63 2739.944 1679.054 0.109

Non‑assurance 15 2308.181 2172.142

BMI: Body mass index

Table 8: Effect of switching on the length of stay and cost of


Variables n Mean Standard



Length (day)

Switching group 39 5.56~6 2.1 0.619

Non‑switching group 39 5.89~6 2.35

Cost (rupiah)

Switching group 39 2400.980 1340.565 0.475

Non‑switching group 39 2912.844 2113.276

Table 9: Relationship between independent variables,

dependent variables, and confounding variables with respect to

patients’ treatment

Variables B Beta p R2


Comorbidity –2.422 –0.351 0.001 0.165

Payment status –1.099 –0.196 0.067


Antibiotic switching 66,6563.58 0.189 0.082 0.152

Comorbidity –2.011 –0.364 0.001

be discharged as soon as their clinical condition is stable, they present no

active medical problems, and have a safe environment in which to continue

therapy [19]. Switching can also reduce the cost of antibiotics significantly

but does not reduce hospitalization costs. This is due to the presence of

comorbidities. Thus, even though the cost of antibiotics is reduced, other

drug costs are still incurred through actions, support, and treatments taken

to combat the comorbidities. The results of this study are consistent with

some previous works. For example, according to a study in Switzerland [9],

the use of checklists as a reminder of the criteria for intravenous oral

antibiotic switching may significantly reduce the duration of intravenous

antibiotics. However, the decrease in the length of hospitalization was

not found to be statistically significant. A retrospective observational

study in Lebanon [6] reported that the duration of intravenous antibiotics

administered in the switching group was shorter than that in the nonswitching

group. The length of hospitalization in the switching group was

shorter than in the switching group, but these results were not significant

either. Different results were found in a study on antibiotic switching in

severe community-acquired pneumonia patients in the Netherlands. The

study reported that switching antibiotics can significantly reduce the

duration of intravenous administration and the length of hospitalization.

Suggestions for further research include the need to examine the role

of clinical pharmacists in intravenous to oral switching of antibiotics

Table 10: The effects of switching against the length and cost of

using antibiotics among patients

Variables n Mean Standard



Duration (day)

Switching group 39 3.49 1.19 0.000

Non‑switching group 39 5.67 2.33

Cost (rupiah)

Switching group 39 46.478 51.947 0.003

Non‑switching group 39 114.781 169.660

Int J App Pharm, Special Issue (October)

Pranandari et al.

Early switch and early discharge strategies in patients with

community-acquired pneumonia: A meta-analysis. Arch Intern Med


Di Giammarino L, Bihl F, Bissig M, Bernasconi B, Cerny A,

Bernasconi E. Evaluation of prescription practices of antibiotics in a

medium-sized Swiss hospital. Swiss Med Wkly 2005;135(47-48):710-4.

Dunn K, O’Reilly A, Silke B, Rogers T, Bergin C. Implementing a

pharmacist-led sequential antimicrobial therapy strategy: A controlled

before-and-after study. Int J Clin Pharm 2011;33(2):208-14.

Davis SL, Delgado G, McKinnon PS. Pharmacoeconomic

considerations associated with the use of intravenous-to-oral

moxifloxacin for community-acquired pneumonia. Clin Infect Dis

;41 Suppl 2:S136-43.

RSUD Kota Depok. Buku Profil RSUD Kota Depok 2013. Depok:

RSUD Kota Depok; 2013.

Almatsier S, Soetardjo S, Soekatri M. Gizi Seimbang Dalam Daur

Kehidupan. Jakarta: Gramedia Pustaka Utama; 2011.

Low S, Chin MC, Ma S, Heng D, Deurenberg-Yap M. Rationale for

redefining obesity in Asians. Ann Acad Med Singapore 2009;38(1):66-9.

Mertz D, Koller M, Haller P, Lampert ML, Plagge H, Hug B, et al.

Outcomes of early switching from intravenous to oral antibiotics on

medical wards. J Antimicrob Chemother 2009;64(1):188-99.

Senn L, Burnand B, Francioli P, Zanetti G. Improving appropriateness

of antibiotic therapy: Randomized trial of an intervention to foster

reassessment of prescription after 3 days. J Antimicrob Chemother


Kuwabara K, Imanaka Y, Matsuda S, Fushimi K, Hashimoto H,

Ishikawa KB, et al. The association of the number of comorbidities

and complications with length of stay, hospital mortality and LOS

high outlier, based on administrative data. Environ Health Prev Med


Lestari W. Studi Penggunaan Antibiotik berdasarkan Sistem ATC/DDD

dan Kriteria Gyysens di Bangsal Penyakit Dalam RSUP DR.M.D Jamil

Padang [Thesis]. Padang: Universitas Andalas; 2011.

Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD,

Dean NC, et al. Infectious Diseases Society of America/American

Thoracic Society consensus guidelines on the management

of community-acquired pneumonia in adults. Clin Infect Dis

;44 Suppl 2:S27-72.



How to Cite

Pranandari, R., Supardi, S., & Andrajati, R. (2017). PARENTERAL ANTIBIOTIC USAGE PATTERNS AND EFFECTS OF INTRAVENOUS TO ORAL SWITCHING ON THE LENGTH AND COST OF HOSPITALIZATION. International Journal of Applied Pharmaceutics, 9, 85–89.



Original Article(s)