PARENTERAL ANTIBIOTIC USAGE PATTERNS AND EFFECTS OF INTRAVENOUS TO ORAL SWITCHING ON THE LENGTH AND COST OF HOSPITALIZATION
Keywords: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 Mannâ€“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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Table 7: The effect of confounding variables on the length of
hospitalization and cost of treatment
Variables n Mean Standard
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
Assurance 63 5.95~6 2.29 0.052
Nonâ€‘assurance 15 4.80~5 1.66
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
Assurance 63 2739.944 1679.054 0.109
Nonâ€‘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
Switching group 39 5.56~6 2.1 0.619
Nonâ€‘switching group 39 5.89~6 2.35
Switching group 39 2400.980 1340.565 0.475
Nonâ€‘switching group 39 2912.844 2113.276
Table 9: Relationship between independent variables,
dependent variables, and confounding variables with respect to
Variables B Beta p R2
Comorbidity â€“2.422 â€“0.351 0.001 0.165
Payment status â€“1.099 â€“0.196 0.067
Antibiotic switching 66,6563.58 0.189 0.082 0.152
Comorbidity â€“2.011 â€“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 . 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 ,
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  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
Switching group 39 3.49 1.19 0.000
Nonâ€‘switching group 39 5.67 2.33
Switching group 39 46.478 51.947 0.003
Nonâ€‘switching group 39 114.781 169.660
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