Antimicrobial IV to PO switch practices at 9 institutions in Kentucky with Established Antimicrobial Stewardship Programs

Intravenous (IV) to oral (PO) transition of antimicrobial therapy is a common antimicrobial stewardship activity. Inpatient institutions seeking to create new IV to PO switch services or enhance existing services may benefit from a review of practices utilized at other institutions. The objective of this review is to summarize IV to PO switch practices utilized by healthcare institutions with established antimicrobial stewardship programs across Kentucky. The Kentucky Antimicrobial Stewardship Innovation Consortium (KASIC) invited pharmacists on the Advisory Board to share current IV to PO switch practices utilized at their institutions. The submitted documents were evaluated in a systematic approach and summarized. Nine of ten institutions represented by the Advisory Board submitted an IV to PO switch practice document for analysis. All institutions utilized pharmacist-driven protocols to allow automatic conversion from IV to PO for select antimicrobials based on specific patient criteria. All protocols included the following antimicrobials eligible for conversion: azithromycin, doxycycline, fluconazole, levofloxacin, linezolid, and metronidazole. Majority of protocols also had inclusion and exclusion criteria based on patient specific factors such as ability to use the enteral route, clinical stability, and infection type. There was variation in the level of restriction placed on conversion eligibility criteria among protocols. IV to PO switch practices for antimicrobials vary across the state of Kentucky. Institutions should tailor protocols based on specific needs, clinical leadership support, and feasibility of implementation.