J Antimicrob Chemother 2018 Apr 26. Epub 2018 Apr 26.

Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.

Objectives: To evaluate a clinical decision support system (CDSS) based on consensus-based intravenous to oral switch criteria, which identifies intravenous to oral switch candidates.

Methods: A three-step evaluation study of a stand-alone CDSS with electronic health record interoperability was performed at the Erasmus University Medical Centre in the Netherlands. During the first step, we performed a technical validation. Read More

Int J Antimicrob Agents 2018 May 5;51(5):794-798. Epub 2018 Jan 5.

Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France; Université de Lorraine, APEMAC, F-54000 Nancy, France. Electronic address:

Bloodstream infections (BSIs) are common, however international guidelines are available only for methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia and candidaemia. This international ESCMID cross-sectional survey, open from December 2016 to February 2017, explored the management of BSIs by infection specialists. All infection specialists (senior or trainees) giving at least weekly advice on positive blood cultures could participate. Read More

J Eval Clin Pract 2018 04 28;24(2):454-455. Epub 2017 Nov 28.

School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia.

J Infect Chemother 2018 Jan 16;24(1):40-44. Epub 2017 Nov 16.

Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, Japan.

An early switch from intravenous to oral antimicrobial therapy is useful for reducing the duration of the hospitalization in adult patients with community acquired-pneumonia, whereas the efficacy of switch therapy for pediatric patients with community acquired (CA)-lower respiratory tract infection (LRTI) is uncertain. The aim of this study is to investigate the efficacy of switch therapy for LRTI in patients with severe motor intellectual disabilities (SMID). This retrospective study was performed on 92 patients with SMID who were admitted to the Department of Pediatrics at the Hospital of University of Occupational and Environmental Health, Japan from April 1, 2010 to March 31, 2017 for the suspicion of bacterial LRTI and were initially treated with an intravenous antimicrobial agent. Read More

Antimicrob Resist Infect Control 2017 15;6:81. Epub 2017 Aug 15.

Department of Internal Medicine, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands.

Background: Timely switch from intravenous (iv) antibiotics to oral therapy is a key component of antimicrobial stewardship programs in order to improve patient safety, promote early discharge and reduce costs. We have introduced a time-efficient and easily implementable intervention that relies on a computerized trigger tool, which identifies patients who are candidates for an iv to oral antibiotic switch.

Methods: The intervention was introduced on all internal medicine wards in a teaching hospital. Read More

Future Microbiol 2017 08 7;12:847-851. Epub 2017 Jul 7.

Zydus Research Center, Cadila Health Care Ltd, Sarkhej-Bavla NH No 8A, Moraiya, Ahmedabad 382 210, Gujarat, India.

J Med Chem 2017 May 24;60(9):3755-3775. Epub 2017 Apr 24.

Actelion Pharmaceuticals Ltd. , Gewerbestrasse 16, CH-4123 Allschwil, Switzerland.

Our strategy to combat resistant bacteria consisted of targeting the GyrB/ParE ATP-binding sites located on bacterial DNA gyrase and topoisomerase IV and not utilized by marketed antibiotics. Screening around the minimal ethyl urea binding motif led to the identification of isoquinoline ethyl urea 13 as a promising starting point for fragment evolution. The optimization was guided by structure-based design and focused on antibacterial activity in vitro and in vivo, culminating in the discovery of unprecedented substituents able to interact with conserved residues within the ATP-binding site. Read More

J Eval Clin Pract 2017 Aug 7;23(4):848-852. Epub 2017 Mar 7.

Department of Pharmacy, Groupe Hospitalier Paris Saint-Joseph, Paris, France.

Rationale, Aims, And Objectives: Intravenous (IV) to oral (PO) drug switch is a challenge for tertiary care institutions for several reasons: catheter-related infections, patient's pain and discomfort or higher costs, and overuse of IV drugs considered as an irrational use of medicines. The objective was to evaluate yearly acetaminophen and proton-pump inhibiters' (PPIs) IV/PO ratios from 2011 to 2015 and to determine their correlation with all drugs IV/PO ratios and their relevance as drug tracers. A secondary objective was to estimate costs savings associated with a IV to PO switch improvement. Read More

Enferm Infecc Microbiol Clin 2017 Jan;35 Suppl 1:41-45

Servicio de Farmacia, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España. Electronic address:

The economic cost of treating an infection can be influenced by multiple factors related to patient characteristics, the type of infection, the isolated microorganism and some mechanisms of bacterial resistance. Of these, the factor generating the largest number of studies is bacterial resistance but many of these studies show major limitations. Antimicrobial stewardship has been proposed as a means to reduce the economic cost of treating infections. Read More

J Antimicrob Chemother 2017 02 20;72(2):543-546. Epub 2016 Dec 20.

Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.

Objectives: Despite huge overlap in suggested criteria for a safe intravenous (iv)-to-oral antibiotic switch, there is considerable variation in their operationalization. The objective of this study was to develop a set of measurable conditions that should be met in adult hospitalized patients for a safe iv-to-oral switch.

Methods: A RAND-modified Delphi procedure was performed to develop a set of operationalized iv-to-oral switch criteria. Read More

Int J Hematol 2017 Mar 7;105(3):361-368. Epub 2016 Nov 7.

Department of Pharmacy, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.

The aim of this retrospective study was to identify variable factors affecting tacrolimus blood concentration during the switch from continuous intravenous infusion to twice-daily oral administration in allogeneic hematopoietic stem cell transplant recipients (n = 73). The blood concentration/dose ratio of tacrolimus immediately before the change from continuous infusion (C/Div) was compared with that between 3 and 5 days after the change to oral administration (C/Dpo). Median (C/Dpo)/(C/Div) was 0. Read More

Int J Antimicrob Agents 2016 Nov 20;48(5):498-503. Epub 2016 Aug 20.

Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine, Columbia, SC, USA. Electronic address:

There is paucity of data evaluating intravenous-to-oral antibiotic switch options for Gram-negative bloodstream infections (BSIs). This retrospective cohort study examined the effectiveness of oral antibiotics for definitive treatment of Gram-negative BSI. Patients with Gram-negative BSI hospitalised for <14 days at Palmetto Health Hospitals in Columbia, SC, from 1 January 2010 through 31 December 2013 and discharged on oral antibiotics were included in this study. Read More

Ann Am Thorac Soc 2017 Feb;14(2):200-205

2 Division of Infectious Diseases, Intermountain Healthcare, Murray, Utah.

Rationale: Guidelines recommend a switch from intravenous to oral antibiotics once patients who are hospitalized with pneumonia achieve clinical stability. However, little evidence guides the selection of an oral antibiotic for patients with health care-associated pneumonia, especially where no microbiological diagnosis is made.

Objectives: To compare outcomes between patients who were transitioned to broad- versus narrow-spectrum oral antibiotics after initially receiving broad-spectrum intravenous antibiotic coverage. Read More

World J Clin Pediatr 2016 Aug 8;5(3):244-50. Epub 2016 Aug 8.

Nathan Batchelder, Tsz-Yin So, Department of Pharmacy, Moses H. Cone Memorial Hospital, Greensboro, NC 27401, United States.

Osteomyelitis is a bone infection that requires prolonged antibiotic treatment and potential surgical intervention. If left untreated, acute osteomyelitis can lead to chronic osteomyelitis and overwhelming sepsis. Early treatment is necessary to prevent complications, and the standard of care is progressing to a shorter duration of intravenous (IV) antibiotics and transitioning to oral therapy for the rest of the treatment course. Read More

PLoS One 2016 17;11(8):e0160551. Epub 2016 Aug 17.

Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.

Background: To promote appropriate antimicrobial use in bloodstream infections (BSIs), we initiated an intervention program consisting of electronic alerts and automated infectious diseases consultations in which the identification and antimicrobial susceptibility test (ID/AST) results were reported.

Methods: We compared the appropriateness of antimicrobial prescriptions and clinical outcomes in BSIs before and after initiation of the program. Appropriateness was assessed in terms of effective therapy, optimal therapy, de-escalation therapy, and intravenous to oral switch therapy. Read More

Pharmazie 2016 Jun;71(6):320-6

Paclitaxel (PTX), a BCS class IV drug that is characterized by its poor solubility and is a substrate for P-glycoprotein, is one of the most widely used antineoplastic agents. However, oral administration of PTX for chemotherapy is highly challenging. The aim of this study was to develop bile-salt liposomes (BS-Lips) to enhance the absorption of PTX and thus improve its therapeutic outcome. Read More

Clin Infect Dis 2016 Oct 22;63(8):1007-1016. Epub 2016 Jul 22.

Cempra Inc, Chapel Hill, North Carolina.

Background: Solithromycin, a novel macrolide antibiotic with both intravenous and oral formulations dosed once daily, has completed 2 global phase 3 trials for treatment of community-acquired bacterial pneumonia.

Methods: A total of 863 adults with community-acquired bacterial pneumonia (Pneumonia Outcomes Research Team [PORT] class II-IV) were randomized 1:1 to receive either intravenous-to-oral solithromycin or moxifloxacin for 7 once-daily doses. All patients received 400 mg intravenously on day 1 and were permitted to switch to oral dosing when clinically indicated. Read More

Lancet Infect Dis 2016 08 16;16(8):e139-52. Epub 2016 Jun 16.

Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia. Electronic address:

Few studies are available to inform duration of intravenous antibiotics for children and when it is safe and appropriate to switch to oral antibiotics. We have systematically reviewed antibiotic duration and timing of intravenous to oral switch for 36 paediatric infectious diseases and developed evidence-graded recommendations on the basis of the review, guidelines, and expert consensus. We searched databases and obtained information from references identified and relevant guidelines. Read More

Rev Chilena Infectol 2016 Apr;33(2):177-86

Community acquired pneumonia (CAP) is an important cause of morbidity and mortality around the world, with high treatment costs due to hospitalization and complications (adverse events due to medications, antibiotic resistance, healthcare associated infections, etc.). It has been proposed administration of short courses and early switch of intravenous administration to oral therapy to avoid costs and complications. Read More

Eur J Clin Microbiol Infect Dis 2016 Aug 14;35(8):1269-76. Epub 2016 May 14.

Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.

Switching from intravenous to oral antibiotic therapy may improve inpatient management and reduce hospital stays and the complications of intravenous treatment. We aimed to assess the effectiveness of intravenous-to-oral antibiotic switch therapy and an early discharge algorithm in hospitalized patients with gram-positive infection. We performed a prospective cohort study with a retrospective comparison cohort, recruited from eight tertiary, acute-care Spanish referral hospitals. Read More

J Antimicrob Chemother 2016 08 27;71(8):2295-9. Epub 2016 Apr 27.

School of Social Sciences, The University of New South Wales, Sydney, NSW 2052, Australia

Objectives: Escalating antimicrobial resistance worldwide necessitates urgent optimization of antimicrobial prescribing to preserve antibiotics for future generations. Early intravenous (iv) to oral switch campaigns are one strategy that hospital-based antimicrobial stewardship programmes can incorporate to minimize inappropriate antibiotic use. Yet, iv antibiotics continue to be offered for longer than is clinically indicated, increasing hospital length of stay, increasing costs and placing patients at risk (e. Read More

Lancet Infect Dis 2016 Jul 3;16(7):847-856. Epub 2016 Mar 3.

Department of Internal Medicine, Division of Infectious Diseases, Centre for Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, Amsterdam, Netherlands. Electronic address:

Background: Antimicrobial stewardship is advocated to improve the quality of antimicrobial use. We did a systematic review and meta-analysis to assess whether antimicrobial stewardship objectives had any effects in hospitals and long-term care facilities on four predefined patients' outcomes: clinical outcomes, adverse events, costs, and bacterial resistance rates.

Methods: We identified 14 stewardship objectives and did a separate systematic search for articles relating to each one in Embase, Ovid MEDLINE, and PubMed. Read More

Artif Intell Med 2016 Mar 22;68:29-36. Epub 2016 Feb 22.

Department of Microbiology and Infectious Diseases, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Québec, Canada J1H 5N4. Electronic address:

Objective: Antimicrobial stewardship programs have been shown to limit the inappropriate use of antimicrobials. Hospitals are increasingly relying on clinical decision support systems to assist in the demanding prescription reviewing process. In previous work, we have reported on an emerging clinical decision support system for antimicrobial stewardship that can learn new rules supervised by user feedback. Read More

Trials 2015 Oct 9;16:450. Epub 2015 Oct 9.

Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstr. 19-21, D-50935, Köln, Germany.

Background: Current guidelines recommend that patients with Staphylococcus aureus bloodstream infection (SAB) are treated with long courses of intravenous antimicrobial therapy. This serves to avoid SAB-related complications such as relapses, local extension and distant metastatic foci. However, in certain clinical scenarios, the incidence of SAB-related complications is low. Read More

Infect Dis Ther 2015 Sep 11;4(Suppl 1):15-25. Epub 2015 Sep 11.

Department of Pharmacy, Singapore General Hospital, Singapore, Singapore.

Introduction: Acute bacterial skin and skin structure infections (ABSSSIs) are among the most common infections treated in hospitals, but to date, there has been little information with regards to the implementation of Antimicrobial Stewardship Programs (ASPs) for patients with ABSSSIs. Hence, we aim to evaluate the impact of ASPs on the following outcomes in patients with ABSSSIs: duration of therapy and hospital stay, 14-day reinfection, infection-related readmissions and mortality.

Methods: A retrospective review of the ASP database was conducted, focusing on selected outcomes (as above) among all patients in whom the institution's ASP recommended a change in antibiotic regimen-de-escalation of the antibiotic based on culture results; discontinuation of the antibiotic; narrowing of the empirical coverage; and intravenous-to-oral (i. Read More

Respir Investig 2015 Sep 4;53(5):225-31. Epub 2015 Aug 4.

Division of Pulmonary Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo City, Tokyo 104-8560, Japan. Electronic address:

Background: Previous reports have documented the efficacy of an early switch from intravenous to oral antimicrobials in community-acquired pneumonia, but not aspiration pneumonia. Therefore, we assessed the feasibility and efficacy of these newly developed criteria for community-acquired pneumonia in patients with aspiration pneumonia.

Methods: This prospective observational study included consecutive patients admitted with aspiration pneumonia over a 10-month period at St. Read More

Can J Hosp Pharm 2015 Jul-Aug;68(4):318-26

BScPhm, ACPR, FCSHP, is currently Antimicrobial Stewardship Program Lead with Public Health Ontario (on leave from her position as Antimicrobial Pharmacy Specialist with the Pharmacy Department, The Ottawa Hospital, Ottawa, Ontario.).

Background: Many health care institutions are in the process of establishing antimicrobial stewardship programs. Changing the route of administration of antimicrobial agents from intravenous to oral (IV to PO) is a simple, well-recognized intervention that is often part of an antimicrobial stewardship program. However, the attending health care team may have concerns about making this switch. Read More

Int J Antimicrob Agents 2015 Oct 21;46(4):428-33. Epub 2015 Jul 21.

Research Center for Medical Informatics, University Hospital Zurich and University of Zurich, Zurich, Switzerland. Electronic address:

Unlabelled: Paper-based interventions have been shown to stimulate switching from intravenous (i.v.) to oral (p. Read More

Med Res Rev 2015 Nov 17;35(6):1268-99. Epub 2015 Aug 17.

School of Pharmacy, Shenyang Pharmaceutical University, Wenhua Road, Shenyang, 110016, China.

Cisplatin and its platinum (Pt) (II) derivatives play a key role in the fight against various human cancers such as testicular, ovarian, head and neck, lung tumors. However, their application in clinic is limited due to dose- dependent toxicities and acquired drug resistances, which have prompted extensive research effort toward the development of more effective Pt (II) delivery strategies. The synthesis of Pt (IV) complex is one such an area of intense research fields, which involves their in vivo conversion into active Pt (II) molecules under the reducing intracellular environment, and has demonstrated encouraging preclinical and clinical outcomes. Read More

Ann R Coll Surg Engl 2015 Sep 14;97(6):451-5. Epub 2015 Aug 14.

University Hospitals of North Midlands NHS Trust , UK.

Introduction: Spondylodiscitis refers to the infection of the intervertebral disc and osteomyelitis of the adjacent endplates, and it is uncommon in the developed world. Broad consensus indicates its incidence is on the rise.

Methods: The aim of this retrospective study was twofold. Read More

Clin Microbiol Infect 2015 Sep 18;21 Suppl 2:S47-55. Epub 2015 Jul 18.

Klinikum Peine, Academic Hospital of Medical University Hannover, Peine, Germany.

Early switch (ES) from intravenous (IV) to oral antibiotic therapy programmes is increasingly included as a component of hospital antimicrobial stewardship initiatives that aim to optimize antimicrobial therapy while limiting toxicity and resistance. In terms of prioritizing the most cost-effective stewardship interventions, ES has been seen as a 'low-hanging fruit', which refers to selecting the most obtainable targets rather than confronting more complicated issues. Administration of highly bioavailable oral antibiotics should be considered for nearly all non-critically ill patients and has been recommended as an effective and safe strategy for over two decades. Read More

Springerplus 2014 9;3:717. Epub 2014 Dec 9.

School of Pharmacy, Department of Clinical Pharmacy, Lebanese International University, Mazraa, 146404 Beirut, Lebanon.

Hospitalized patients initially on intravenous antibiotics can be safely switched to an oral equivalent within the third day of admission once clinical stability is established. This conversion has many advantages as fewer complications, less healthcare costs and earlier hospital discharge. The three types of intravenous to oral conversion include sequential, switch, and step-down therapy. Read More

J Antimicrob Chemother 2015 Apr 23;70(4):965-70. Epub 2014 Dec 23.

NHS Greater Glasgow and Clyde, Brownlee Centre, Gartnavel General Hospital, Glasgow G12 0YN, UK.

Outpatient parenteral antimicrobial therapy (OPAT) has become, for many countries, an established form of healthcare delivery. At the same time, there have been calls to ensure the prudent use of the existing antimicrobial armamentarium. For OPAT, this presents a dilemma. Read More

Antimicrob Agents Chemother 2015 Feb 1;59(2):1004-13. Epub 2014 Dec 1.

Clinical Pharmacology, Global Established Pharma Business, Pfizer, Inc., Groton, Connecticut, USA.

The aim of this study was to investigate the pharmacokinetics, safety, and tolerability of voriconazole following intravenous-to-oral switch regimens used with immunocompromised Japanese pediatric subjects (age 2 to <15 years) at high risk for systemic fungal infection. Twenty-one patients received intravenous-to-oral switch regimens based on a recent population pharmacokinetic modeling; they were given 9 mg/kg of body weight followed by 8 mg/kg of intravenous (i.v. Read More

Curr Opin Infect Dis 2015 Feb;28(1):106-11

aDepartment of Infectious Diseases, Leiden University Medical Center, Leiden bDepartment of Internal Medicine, Haga Hospital, The Hague, the Netherlands.

Purpose Of Review: To review the recent advances in the diagnostic and therapeutic approach to adults presenting with febrile urinary tract infection (UTI) in the emergency department (ED).

Recent Findings: Recent research suggests overdiagnosis and therefore overtreatment of UTI in the ED, especially in the elderly. Antimicrobial pretreatment, an indwelling catheter, and malignancy are independent risk factors for bacteremia with uropathogens that cannot be cultured from urine. Read More

Clin Infect Dis 2015 Jan 28;60(2):281-91. Epub 2014 Sep 28.

Department of Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.

Background: An important requirement for an effective antibiotic stewardship program is the ability to measure appropriateness of antibiotic use. The aim of this study was to develop quality indicators (QIs) that can be used to measure appropriateness of antibiotic use in the treatment of all bacterial infections in hospitalized adult patients.

Methods: A RAND-modified Delphi procedure was used to develop a set of QIs. Read More

Expert Rev Pharmacoecon Outcomes Res 2014 Oct 25;14(5):741-9. Epub 2014 Jul 25.

Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA.

Objectives were to evaluate correlates, and economic outcomes of proton pump inhibitor (PPI) use by route in the intensive care unit from an institutional-payer perspective. A 13-month retrospective study of electronic medical records was conducted of 534 adult (≥19 year-old) intensive care unit patients receiving a PPI (39% enteral-only, 34% parenteral-only, 27% both-route) in a Midwest USA academic medical center. Possible cost-savings with sensitivity analysis were estimated as differences in drug costs (US dollars) between switch eligible parenteral and alternate enteral-PPI medication doses. Read More

Int J Antimicrob Agents 2014 Jul 16;44(1):56-64. Epub 2014 May 16.

Pfizer Inc., Groton, CT, USA.

This retrospective observational medical chart review aimed to describe country-specific variations across Europe in real-world meticillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft-tissue infection (cSSTI) treatment patterns, antibiotic stewardship activity, and potential opportunities for early switch (ES) from intravenous (i.v.) to oral formulations and early discharge (ED) from hospital using standardised data collection and criteria and economic implications of these opportunities. Read More

J Pharmacol Pharmacother 2014 Apr;5(2):83-7

Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Health Science Campus, Amrita Vishwa Vidyapeetham University, Ponekkara, Kochi, Kerala, India.

Majority of the patients admitted to a hospital with severe infections are initially started with intravenous medications. Short intravenous course of therapy for 2-3 days followed by oral medications for the remainder of the course is found to be beneficial to many patients. This switch over from intravenous to oral therapy is widely practiced in the case of antibiotics in many developed countries. Read More

Pharmacoepidemiol Drug Saf 2014 Sep 2;23(9):933-41. Epub 2014 May 2.

Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway.

Background/purpose: Community-acquired pneumonia (CAP) is a disease with high morbidity and mortality. Adherence to clinical practice guidelines (CPGs) in treatment of CAP is associated with favourable outcome. We aimed to develop and validate a medication assessment tool (MAT) to explore adherence to CPG recommendations in patients with CAP admitted to a Norwegian hospital. Read More

J Infect Chemother 2014 Jul 29;20(7):429-35. Epub 2014 Apr 29.

Clinical Research, Development Japan, Pfizer Japan Inc., Tokyo, Japan. Electronic address:

Unlabelled: Pelvic inflammatory disease (PID) is mainly caused by ascending infection from the vaginal flora including the sexually transmitted organisms, Neisseria gonorrhoeae and Chlamydia trachomatis, and lower genital tract endogenous anaerobes, leading to serious consequences including infertility and ectopic pregnancy. To evaluate the efficacy and safety of azithromycin in the treatment of PID that requires initial intravenous therapy, we conducted a multicenter, unblinded, non-comparative phase 3 trial. Intravenous azithromycin (500 mg, once daily) for 1 or 2 days followed by oral azithromycin (250 mg once daily) to complete a total of 7 days treatment was administered to 60 Japanese women with acute PID. Read More

Clin Microbiol Infect 2014 Jun;20 Suppl 6:11-8

Department of Internal Medicine, Charité University Medicine, Berlin, Germany.

Bloodstream and other invasive infections due to Candida species (invasive fungal diseases = IFD) are a major cause of morbidity and mortality in hospitalized adults and children in many countries worldwide. The high infection-related morbidity and mortality associated with invasive Candida infection/candidaemia (IC/C), combined with suboptimal diagnostic tools, have driven the overuse of antifungal drugs. Antifungal stewardship (AFS) may be regarded as subentity of the more general term Anti-infective or Antimicrobial Stewardship Program (AIS/AMS). Read More

J Antimicrob Chemother 2014 Jul 21;69(7):1993-9. Epub 2014 Mar 21.

Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.

Objectives: To assess the quality of antifungal use, to propose a point score for this evaluation and to estimate the potential economic savings of an antifungal stewardship programme.

Methods: From December 2010 to January 2011, we identified 100 adult inpatients receiving systemic antifungals. Antifungal use was evaluated by means of a predefined score that considered indication, drug selection, dosage, adjustments after microbiology results, switching to an oral agent and length of treatment. Read More

Clin Microbiol Infect 2014 Apr;20 Suppl 4:3-18

Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.

Complicated skin and soft tissue infections (cSSTIs) are a diverse group of infections, with a range of presentations and microbiological causes. Hospitalization is common for patients with a cSSTI, which is treated by drainage of the affected area and with antibiotics. Host factors such as co-morbidities, and microbial factors, in particular drug resistance, complicate the management of these infections. Read More

Eur J Haematol 2014 Jul 19;93(1):34-40. Epub 2014 Mar 19.

Clinical Hematology Division, Instituto de Hematologia Arthur de Siqueira Cavalcanti - HEMORIO, Rio de Janeiro, Brazil.

Objectives: Describe the treatment of patients with vaso-occlusive crises (VOC) in a Brazilian emergency department (ED) and the successful switch from intravenous to oral morphine.

Patients And Methods: We analyzed records of 315 patients with sickle cell disease using two different protocols for pain: one in March 2010 prescribing intravenous morphine every 4 h throughout their stay, and another in March 2011 and 2012 prescribing one initial dose of intravenous morphine followed by equianalgesic doses of oral morphine every 4 h. Patients were triaged into three groups: mild, moderate, and severe VOC. Read More

Int J Pharm Pract 2014 Oct 27;22(5):345-53. Epub 2014 Jan 27.

Pharmacy Department, University Hospitals Bristol NHS Foundation Trust, Bristol, Wales, UK.

Objectives: To identify reasons for poor adherence to antibiotic intravenous-to-oral switch guidelines and to explore the possible solutions. To rate the importance of the barriers and solutions identified, as perceived by a multidisciplinary expert panel.

Methods: Three-round Delphi study in an expert panel comprising doctors, nurses and pharmacists, with concurrent semi-structured interviews. Read More

J Control Release 2014 Feb 2;176:94-103. Epub 2014 Jan 2.

Department of Biopharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China. Electronic address:

Nanohybrid drug delivery systems have presented lots of characteristic advantages as an efficient strategy to facilitate oral drug delivery. Nonetheless, oral administration of chemotherapy agents by nanoparticulate delivery technology still faces great challenges owing to the multiple biobarriers ranging from poorly physicochemical properties of drugs, to complex gastrointestinal disposition and to presystemic metabolism. This review briefly analyzes a series of biobarriers hindering oral absorption and describes the multiple aspects for facilitating the intravenous-to-oral switch in cancer therapy. Read More

J R Coll Physicians Edinb 2013 ;43(4):294-300

AD McCallum, Regional Infectious Diseases Unit Western General Hospital Crewe Road, Edinburgh EH4 2XU,UK.

Antimicrobial stewardship programmes reduce the risk of hospital associated infections (HAI) and antimicrobial resistance, and include early intravenous-to-oral switch (IVOS) as a key stewardship measure. We audited the number of patients on intravenous antimicrobials suitable for oral switch, assessed whether prescribing guidelines were followed and reviewed prescribing documentation in three clinical areas in the Western General Hospital, Edinburgh, in late 2012. Following this, the first cycle results and local guidelines were presented at a local level and at the hospital grand rounds, posters with recommendations were distributed, joint infection consult and antimicrobial rounds commenced and an alert antimicrobial policy was introduced before re-auditing in early 2013. Read More

Int J Clin Pract 2014 Jan;68(1):20-7

Department of Microbiology, University Hospital Crosshouse, Kilmarnock, UK.

Aims: Echinocandins are recommended for the treatment of candidaemia in moderately severe to severely ill patients. Step-down or de-escalation from echinocandin to fluconazole is advised in patients who are clinically stable but data in relation to step-down therapy are sparse. Using our hospital intravenous to oral switch therapy (IVOST) policy to guide antifungal de-escalation in patients with candidaemia, we aimed to determine what proportion of patients are de-escalated to fluconazole, the timescale to step-down, associated reduction in consumption of echinocandins and antifungal cost savings. Read More

Acta Clin Belg 2013 May-Jun;68(3):179-82

Research Center for Clinical Pharmacy, University Hospitals Leuven, Leuven, Belgium.

Introduction: Early switch from intravenous to oral administration of drugs with an almost complete oral bioavailability, can have important benefits. Drugs with almost complete bioavailability, like clindamycin (Dalacin), levofloxacin (Tavanic) and paracetamol (Perfusalgan/Dafalgan), are very suitable for an early intravenous to oral switch in patients whose gastrointestinal absorption is intact. The aim of this study was to investigate the impact of direct phone contact between pharmacist and clinician on the intravenous to oral switch and to evaluate the reasons, mentioned by clinicians, that prevented an early switch. Read More