Implementing a pharmacist-led sequential antimicrobial therapy strategy: a controlled before-and-after study

Int J Clin Pharm. 2011 Apr;33(2):208-14. doi: 10.1007/s11096-010-9475-9. Epub 2011 Jan 25.


Sequential antimicrobial therapy is an important part of antimicrobial stewardship and intends to improve the timeliness of switch to oral antimicrobials. The aim of this study was to assess the impact of the introduction of guidelines and criteria for switching to oral antimicrobials.

Setting: The study was conducted in a 753-bed academic hospital in Ireland.

Methods: The study was prospective and of controlled before and after design. Patients admitted under the care of a medical consultant were screened for inclusion. The study was divided into pre-intervention and post-intervention phases. Patients admitted and prescribed IV antimicrobials were enrolled into either a study group or control group. Post-intervention, the intervention to the study group consisted of application of stickers and criteria for switch to oral antimicrobial therapy to the drug chart. Pre-intervention in the study group and in both phases in the control group, conventional practice of clinical pharmacists reviewing drug charts and contacting prescribers to discuss a switch to an oral antimicrobial continued. The duration of intravenous treatment, the timeliness of switch to oral therapy, length of stay and cost savings were measured.

Main outcome measure: The duration of intravenous antimicrobial therapy in the pre-intervention and post-intervention phases in both study and control groups.

Results: Pre-intervention, 85 courses of IV antimicrobials were prescribed to study group patients, compared to 60 in the control group. Post-intervention, there were 92 courses in the study group and 53 in the control group. The duration of IV antimicrobial treatment reduced significantly in the study group post-intervention, compared to the control group (P = 0.02). The timeliness of the switch also improved significantly in the study group post-intervention (P = 0.017). No improvement occurred in the control group. The median length of stay was not reduced post-intervention. Antimicrobial costs reduced by a mean of €6.41 in the study group post-intervention.

Conclusion: This controlled before and after study demonstrates successful implementation of a pharmacist-led antimicrobial stewardship strategy. Duration of IV antimicrobial treatment reduced significantly and the timeliness of switch significantly improved. This study may be used as a template for the introduction of further pharmacist-led antimicrobial stewardship initiatives.

Publication types

  • Controlled Clinical Trial

MeSH terms

  • Administration, Oral
  • Aged
  • Anti-Infective Agents / administration & dosage*
  • Anti-Infective Agents / economics
  • Chi-Square Distribution
  • Cost Savings
  • Drug Administration Schedule
  • Drug Costs
  • Female
  • Guideline Adherence
  • Hospital Costs
  • Hospitals, University
  • Humans
  • Infusions, Intravenous
  • Ireland
  • Length of Stay
  • Male
  • Medical Records
  • Middle Aged
  • Pharmacists* / economics
  • Pharmacy Service, Hospital* / economics
  • Practice Guidelines as Topic
  • Professional Role*
  • Prospective Studies
  • Time Factors
  • Treatment Outcome


  • Anti-Infective Agents