‘From pipes to pills’: Switch from IV to oral antibiotics

As “Plastic Free July” concludes, the Sustainability team wants to share a project that grants us environmental, patient and economic benefits.

Caroline Hallam, Antimicrobial Specialist Pharmacist, has introduced an initiative aimed at shifting away from intravenous (IV) antibiotics to the more environmentally friendly alternative of oral administration.

Currently 26% of antibiotic treatments are via the intravenous route in NHS acute hospitals in England, with the East of England showing a higher-than-average prevalence for this practice. Approximately 17 million days of treatment with IV antimicrobials are dispensed each year, and an estimated 30% (5 million days) of these may be unnecessary.

To address this issue, a CQUIN project (Commissioning for Quality and Innovation) is prompting the switch from IV antimicrobial treatment to oral when patients meet the right criteria. Many antibiotics offer no added benefit when given intravenously, except in cases where oral administration is not feasible (metronidazole, ciprofloxacin, clarithromycin, linezolid, clindamycin and rifampicin).

“IV solution bags and their administration systems are one of the top six types of single use plastics in a typical hospital,” said Amy Greengrass, Clinical Lead for Sustainability (pictured).

“The move from IV to oral offers a significant reduction in carbon footprint, with a seven-day course of oral ciprofloxacin having a carbon footprint of only 1kg compared to a comparable IV route which would have a footprint of 67kg.

“Our Green Plan looks to reduce single use plastics by 50% by 2025 as well as eliminate them entirely in non-clinical settings.

“In addition, medicines account for 25% of our carbon footprint so it is critical we continue to explore new ways of bringing this figure down, particularly when the patient outcomes are consistent.”

Beyond the inherent sustainability advantages, moving from IV to oral treatment has several patient benefits. Patients experience shorter hospital stays and fewer adverse line-related events. Additionally, incidences of bloodstream/line and healthcare-associated infections, broad-spectrum antibiotic exposure, and antimicrobial resistance are significantly reduced. Patient experience is also improved, as they are more likely to receive accurate doses on time and are less likely to miss doses.

“There are so many benefits of reducing unnecessary IV antibiotics, better patient care, cost savings, freeing up nursing time whilst also supporting the NHS Green Agenda,” said Caroline.

The impact of this switch goes even further, benefiting nursing staff and healthcare finances. By making the transition, we could free up a substantial 10,750 nursing hours per year.

Furthermore, drug cost savings of approximately £100,000 per year contribute alongside the freed-up nursing hours to a total potential saving of close to £300,000 annually. Not to mention, the project plays a vital role in reducing the hospital’s carbon footprint and minimizing the use of single-use plastics.