ArticleAntimicrobial stewardship & healthcare epidemiology : ASHE2026
Azithromycin and doxycycline intravenous and oral administrations before and after prescriber-facing alert for intravenous fluid conservation.
Article in Antimicrobial stewardship & healthcare epidemiology : ASHE, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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4 authors.
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Abstract
Objective: Intravenous (IV) to oral (PO) antimicrobial stewardship initiatives can be implemented by various healthcare providers in conjunction with clinical decision support tools. Our study evaluated the impact of a prescriber-facing IV to PO alert on azithromycin and doxycycline prescribing, acquisition cost, and waste generated. Methods: Our institution implemented an IV to PO alert at order entry for IV azithromycin and IV doxycycline with alternative dosage forms included. All emergency department and inpatient IV and PO azithromycin and doxycycline administrations were included during May 12, 2024 - September 28, 2024 (pre-group) and October 13, 2024 - March 1, 2025 (postgroup). The primary outcome was the change in PO azithromycin and doxycycline administrations over time. Secondary outcomes included cost savings and waste generated. Results: A total of 25,529 azithromycin (56% IV, 43% PO) and 40,584 doxycycline (27% IV, 73% PO) administrations were included in the pre-group. The postgroup included 32,505 azithromycin (22% IV, 78% PO) and 44,601 doxycycline (12% IV, 88% PO) administrations. An increase of almost 38.9% (95% CI 34.9 to 43.0%) in the proportion of PO azithromycin and 17% (95% CI 14.4 to 19.6%) in the proportion of PO doxycycline was observed immediately after alert implementation. Azithromycin and doxycycline total waste decreased by 270.3 and 230.6 kg, respectively. Monthly savings of USD 28,739.48 were calculated for azithromycin and USD 46,637.87 for doxycycline. Conclusion: A prescriber-facing IV to PO alert led to increase PO administrations of azithromycin and doxycycline with reduction in cost and waste generated.
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