Methods: A 4 step international RAND-modified Delphi procedure was performed to develop a set of operationalized IV to oral switch criteria. Switch criteria and their accompanying suggested measurable conditions were extracted from the literature and were appraised by a multidisciplinary expert panel during 2 questionnaire rounds with an in-between face to face meeting. In a final step, the experts could approve the set of developed operationalized switch criteria.
Results: Seven switch criteria and 41 accompanying measurable conditions extracted from the literature were appraised in the 4 step Delphi procedure. The Delphi procedure ultimately resulted in the selection of 16 measurable conditions that operationalize 6 switch criteria: (1) Stable systolic blood pressure. Absence of: (2) fever, (3) under temperature, (4) malabsorption syndrome, (5) short bowel syndrome, (6) severe gastroparesis, (7) ileus, (8) continuous nasogastric suction, (9) vomiting, (10) (severe) sepsis, (11) fasciitis necroticans, (12) central nervous system infection, (13) Staphylococcus aureus bacteremia and (14) endovascular infection. In addition (15) the patient should be cooperative and (16) adequate antimicrobial concentration should be achievable at the site of infection by oral administration.
Conclusion: This systematic stepwise method which combined evidence and expert opinion resulted in a feasible set of 6 intravenous to oral antibiotic switch criteria operationalized by 16 measurable conditions. Future use in audits and as rules in computer assisted decision support systems will facilitate the performance and evaluation of switch projects as important part of antimicrobial stewardship programs.
H. Van Der Sijs, None
J. M. Prins, None
D. Melles, None
A. Verbon, None
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