4CPS-140 Impact of oral sequential therapy on antimicrobial prescribing at a tertiary care hospital

<h3>Background and Importance</h3> Oral sequential therapy (OST) consists of switching parenteral antibiotherapy to oral antimicrobials, with the aim to reduce complications associated with parenteral administration, hospital stay times, treatment duration (TD) and costs. <h3>Aim and Objectives</h3> To describe OST recommendations and its acceptance degree by prescribers. To analyse the impact on inpatient antimicrobial consumption following the OST implementation. <h3>Material and Methods</h3> Descriptive, observational, cross-sectional and prospective study of inpatient ‘OST’ interventions from 11/2023 to 01/2024 inclusive. In addition, hospital antimicrobial consumption data are recorded in 11/2022–01/2023 (‘pre-OST’) and 11/2023–01/2024 (‘post-OST’). Data included: age, diagnosis, administration route, TD, interventions and antimicrobial consumption. Inclusion criteria: parenteral therapy, antimicrobial with oral bioavailability≥60% and TD≥3 days. Exclusion criteria: oral intolerance, sepsis/complicated infections, rising acute phase reactants, altered consciousness, fever and/or haemodynamic instability. <h3>Results</h3> 110 inpatients met the inclusion criteria in the study period {median age of 77 years [interquartile range:(68,88)]}. After applying exclusion criteria [oral intolerance (27 cases), sepsis/complicated infection (24), rising acute phase reactants (16), altered consciousness (1), fever (1)], OST was recommended to 41 inpatients. The acceptance rate was 85.4% (35/41). The action of prescribers after acceptance was: Parenteral to oral antibiotherapy switch during hospitalisation: 74.3%(26 interventions/35 accepted). Discontinuation of antibiotherapy and hospital discharge: 14.3%(5/35). Discontinuation of antibiotherapy, continuing hospitalisation: 8.6%(3/35). Hospital discharge with oral antibiotherapy for home use: 2.8%(1/35). The most recorded antimicrobial was levofloxacin (29/41:70.7%), followed by isavuconazole and amoxicillin/clavulanate (4/41:9.8% in both cases); their hospital consumption was (table 1): <h3>Conclusion and Relevance</h3> Despite of limited sampling size and strict exclusion criteria, a high acceptance degree (&gt;85%) was obtained, also a parenteral therapy reduction and an oral increase was recorded with levofloxacin and isavuconazole. Some acceptances resulted in antibiotherapy discontinuation and/or hospital discharge. Further studies are required to demonstrate advantages like reducing complications associated with parenteral administration, hospital stay times and costs. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest