Economic burden and predictors of early intravenous to oral antimicrobial change for hospitalized patients, Ethiopia: a prospective Comparative study

Background: Short intravenous (IV) antimicrobial therapy for 2-3 days followed by its oral (PO) comparable antimicrobial course is a crucial part of the antimicrobial stewardship program. However, nothing is known about this practice in Ethiopian-hospitals. Thus, it was aimed at assessing the economic burden, treatment outcome, and the practice of early IV to PO antimicrobial changes. Method: A hospital-based prospective Comparative study was conducted. After 3days follow up, the patients were categorized in to intervention and comparator group. Informed written consent was sought. Logistic regression models and independent t-test were done with a significance of p ≤0.05. Results: : Out of 117 patients, 92 (78.6%) of the study participants were clinically stable within 72 hours. Hence, early IV to PO antimicrobial change was done only for 36/92 (39.1%), which resulted in an unnecessary expenditure of at least 29,434.72 Ethiopian Birrs (ETB) (671.39US$) within 3 months. There was a significant difference in terms of mean length of hospital stay (LOS) (8.80±3.57 versus 3.17±0.74; p-value <0.0001), in-hospital complication rate (p-value <0.0001), and the mean cost of healthcare in ETB (652.29±403.29 versus 126.67±29.47; p-value <0.0001) between the intervention and comparator group, respectively. Conclusion: The practice of early IV to PO antimicrobial change was unsatisfactory. There was a significant difference between the intervention and comparator groups in terms of LOS, in-hospital complication, and extra cost. Therefore, possible intervention should be applied, including the establishment of an antimicrobial stewardship program to improve the practice of early IV to PO change.