The utility of an in-hospital observation period after discontinuing intravenous antibiotics


      PURPOSE: To determine whether observing patients overnight in the hospital after intravenous antibiotics have been discontinued is a useful way to identify important clinical events.
      SUBJECTS AND METHODS: We performed a retrospective chart review of patients admitted during a 6-month period to a tertiary care teaching hospital with a primary diagnosis of either pneumonia, urinary tract infection, or cellulitis who were treated with intravenous antibiotics. Charts were abstracted for patient characteristics, including comorbid illnesses and laboratory values, as well as for evidence of recurrent infection or other adverse events.
      RESULTS: Of the 374 patients in the study, 63 (17%) were discharged on the day intravenous antibiotics were discontinued. These patients were 10 years younger (P = 0.0009) and had fewer comorbid illnesses (P = 0.02) than those who were observed in the hospital. Recurrent infection was noted in 3 (1%; 95% confidence interval 0.2% to 3%) of the 308 patients who were observed. A mild adverse antibiotic reaction was also noted in three observed patients. The readmission rate to the same institution for recurrent infection was 3% for patients with an observation period and 2% for patients without an observation period (P = 0.70).
      CONCLUSIONS: Observing patients overnight in the hospital after discontinuing intravenous antibiotics is a common clinical practice. There was an extremely low incidence of adverse events during the observation period, and the events that did occur would have been discovered in an outpatient setting. In-hospital observation after discontinuing intravenous antibiotics is unnecessary for most patients with pneumonia, urinary tract infection, or cellulitis and greatly increases health-care costs.
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        • Farber B.F.
        • Cooper D.J.
        Observing patients after antibiotics are discontinued.
        NEJM. 1995; 333 ([Letter]): 1082-1083
        • Caceres V.M.
        • Strange K.C.
        • Kikano G.E.
        • Zyzanski S.J.
        The clinical utility of a day of hospital observation after switching from intravenous to oral antibiotic therapy in the treatment of pyelonephritis.
        J Fam Pract. 1994; 39: 337-339
      1. Quality screening procedures. Island Peer Review Organization, Rego Park, NY1990
        • Thompson R.L.
        Cephalosporin, carbapenem, and monobactam antibiotics.
        Mayo Clin Proc. 1987; 62: 821-834
        • Wilhelm M.P.
        Mayo Clin Proc. 1991; 66: 1165-1170
        • Powers R.D.
        • Tan J.S.
        • Reisdorff E.J.
        New antimicrobial agents.
        Emerg Med Rep. 1993; 14: 219-226
        • Smilack J.D.
        • Wilson W.R.
        • Cockerill III, F.R.
        Tetracyclines, chloramphenicol, erythromycin, clindamycin, and metronidazole.
        Mayo Clin Proc. 1991; 66: 1270-1280
        • Isselbacher K.
        • Braunwald E.
        • Wilson J.
        Harrison’s Principles of Internal Medicine. 13th ed. McGraw-Hill, New York1994
        • Wyngaarden J.
        • Smith L.
        Cecil’s Textbook of Medicine. 18th ed. WB Saunders Company, Philadelphia, PA1992
        • Mandell G.
        • Douglas R.
        • Bennett J.
        Practice of Infectious Diseases. 5th ed. Churchill Livingstone, New York1995
        • Gorbach S.L.
        • Bartlett J.G.
        • Blacklow N.R.
        Infectious Diseases. WB Saunders Company, Philadelphia, PA1992
      2. International Classification of Diseases, Ninth Revision, Clinical Modification. Washington, DC: Public Health Service, US Dept of Health and Human Services, 1988.

        • Gilbert K.
        • Gleason P.P.
        • Singer D.E.
        • et al.
        Variations in antimicrobial use and cost in more than 2,000 patients with community-acquired pneumonia.
        Am J Med. 1998; 104: 17-27
        • Fine M.J.
        • Medsger A.R.
        • Stone R.A.
        • et al.
        The hospital discharge decision for patients with community-acquired pneumonia.
        Arch Intern Med. 1997; 157: 47-56
        • Bates D.W.
        • Cullen D.J.
        • Laird N.
        • et al.
        Incidence of adverse drug events and potential adverse drug events.
        JAMA. 1995; 274: 29-34
        • Brennan T.A.
        • Leape L.L.
        • Laird N.M.
        • et al.
        Incidence of adverse events and negligence in hospitalized patients.
        NEJM. 1991; 324: 370-376
        • National Center for Health Statistics
        Detailed Diagnoses and Procedures, National Hospital Discharge Survey, 1990.
        Vital Health Stat Series 13. 1992; 113: 1-225