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Canadian Journal of Infectious Diseases
Volume 6, Issue 6, Pages 306-315

Sequential Antibiotic Therapy: Effective Cost Management and Patient Care

Lionel A Mandell,1,5 Michel G Bergeron,1,2,7 Marie J Gribble,3,4,7 Peter J Jewesson,4 Donald E Low,1,2,5,6,7 Thomas J Marrie,1,2,6,7 and Lindsay E Nicolle1,5,7

1Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
2Department of Microbiology, Université Laval and Labratoire et service d’infectiologie, Centre Hospitalier de l’Université Laval, Québec, Canada
3University of British Columbia and Division of Infectious Diseases, University Hospital, Vancouver, British Columbia, Canada
4Faculty of Pharmaceutical Sciences, University of British Columbia and Department of Pharmacy, Department of Medicine, Division of Infectious Diseases, Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada
5Departments of Microbiology and Medicine, University of Toronto and Department of Microbiology, Mount Sinai Hospital and Princess Margaret Hospital, Toronto, Ontario, Canada
6Dalhousie University and Department of Medicine, Victoria General Hospital, Halifax, Nova Scotia, Canada
7Internal Medicine and Medical Microbiology, University of Manitoba and Infection Control Unit, Health Sciences Centre, Winnipeg, Manitoba, Canada

Received 17 May 1995; Accepted 11 August 1995

Copyright © 1995 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The escalating costs associated with antimicrobial chemotherapy have become of increasing concern to physicians, pharmacists and patients alike. A number of strategies have been developed to address this problem. This article focuses specifically on sequential antibiotic therapy (sat), which is the strategy of converting patients from intravenous to oral medication regardless of whether the same or a different class of drug is used. Advantages of sat include economic benefits, patient benefits and benefits to the health care provider. Potential disadvantages are cost to the consumer and the risk of therapeutic failure. A critical review of the published literature shows that evidence from randomized controlled trials supports the role of sat. However, it is also clear that further studies are necessary to determine the optimal time for intravenous to oral changeover and to identify the variables that may interfere with the use of oral drugs. Procedures necessary for the implementation of a sat program in the hospital setting are also discussed.