Pharmacoeconomic and clinical aspect of a sequential intravenous to oral therapy plan in an acute geriatric ward

Effectiveness of antimicrobial stewardship interventions on early switch from intravenous-to-oral antimicrobials in hospitalized adults: A systematic review

BACKGROUND

This review aimed to summarize the available evidence on the effectiveness and safety of antimicrobial stewardship interventions to improve the practice of IV-to-PO antimicrobial switch therapy in hospitalized adults.

METHODS

Following the PRISMA guidelines, we searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE/PubMed, and Scopus from inception to September 1, 2020, for original articles investigating any interventions aimed to improve the practice of IV-to-PO antimicrobial switch therapy in hospitalized adults with infectious diseases. We included randomized controlled trials (RCTs) and quasi-experimental studies. Studies were excluded if they evaluated drugs other than antimicrobials, head-to-head comparison of interventions, included pediatrics or oncology patients.

RESULTS

Of 506 unique citations identified, 36 studies met the inclusion criteria. The 36 included studies reported 92 interventions as a single (n = 10) or a bundle of interventions (n = 26). The most common interventions used were guideline/protocol/pathway (n = 25), audit and feedback (n = 20), and education (n = 17).

CONCLUSIONS

This review provides health care providers with a comprehensive summary on the interventions to promote IV-to-PO antimicrobial switch. While no one intervention could be identified as the safest and most effective as most of the included studies used a bundle of interventions, all interventions resulted in optimizing antibiotic use and reducing health care expenditures without compromising the clinical outcomes. As such, each hospital should design and utilize interventions that are applicable based on available resources and expertise.

Hospital pharmacists working with geriatric patients in Europe: a systematic literature review

Objectives

Multimorbidity of geriatric patients often leads to polypharmacy that increases the risk for drug interactions. Geriatric patients are also more sensitive to adverse drug reactions due to physiological changes resulting from ageing. Hence, the use of medicines should be considered thoroughly. This systematic literature review aimed at identifying and presenting available evidence on the effect of pharmaceutical interventions on geriatric patients, their medications or healthcare costs in a clinical setting in Europe.

Methods

We included all studies on research of pharmaceutical interventions on geriatric inpatients (≥65 years) in Europe since 2001. Database searches were conducted on PubMed, EMBASE, The Cochrane Library and AgeInfo. In addition, the following journals were searched manually: European Journal of Hospital Pharmacy, 'Krankenhauspharmazie', 'Medizinische Monatsschrift für Pharmazeuten' and 'Zeitschrift für Gerontologie und Geriatrie'.

Results

Database screening yielded 8058 hits. After deletion of duplicates, screening of title and abstract, 143 full-text articles were analysed and 17 papers were included. Manual searching added four more papers. Included studies were conducted in Belgium, Denmark, England, Ireland, the Netherlands, Sweden and Spain. They demonstrate that pharmaceutical care on wards leads to more appropriate medication use and might reduce outcomes like drug-related readmissions. Intensified pharmaceutical care showed additional effects, even in countries with established pharmaceutical care in hospitals.

Conclusions

This systematic literature review demonstrates that ward-based pharmacists may improve the appropriateness of medications, seamless care and drug safety for geriatric inpatients while being cost effective.