PARENTERAL ANTIBIOTIC USAGE PATTERNS AND EFFECTS OF INTRAVENOUS TO ORAL SWITCHING ON THE LENGTH AND COST OF HOSPITALIZATION

Authors

  • 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.

DOI:

https://doi.org/10.22159/ijap.2017.v9s1.44_50

Keywords:

Switching antibiotics, Length of stay, Cost

Abstract

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

hospitalization and cost of treatment

Variables n Mean Standard

deviation

p

Length of

hospitalization (days)

Age

Adult 65 5.69~6 2.24 0.591

Elderly 13 5.92~6 2.18

BMI

Underweight 11 5.91~6 2.62 0.907

Not underweight 67 5.70~6 2.17

Comorbidity

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)

Age

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Elderly 13 2832.572 1408.100

BMI

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Not underweight 67 2632.396 1811.281

Comorbidity

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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

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Variables n Mean Standard

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p

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Switching group 39 5.56~6 2.1 0.619

Non‑switching group 39 5.89~6 2.35

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Non‑switching group 39 2912.844 2113.276

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Payment status –1.099 –0.196 0.067

Cost

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

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antibiotic switching may significantly reduce the duration of intravenous

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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

deviation

p

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

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Published

30-10-2017

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. https://doi.org/10.22159/ijap.2017.v9s1.44_50

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