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Background The intravenous administration of antibiotics remains the route of choice at patient admission. Although the early-oral switch once the clinical stability has been achieved, has demonstrated to be effective and safe in other settings, its implementation in the pneumology ward has not been studied. Purpose To assess the effectiveness and safety of an early-oral antimicrobial switch protocol in the pulmonology ward. Material and methods Quasi-experimental study performed in a 400-bed tertiary hospital. The protocol was implemented in March 2018 and therefore two groups were identified: intervention group (March to August 2018) and control group (March to August 2017). All patients admitted to the pneumology ward were treated with intravenous antibiotics that, in turn, were available orally: therefore, amoxicillin/clavulanate, fluoroquinolones, trimethoprim-sulfamethoxazole, clindamycin and azithromycin were included. Results A total of 200 patients were included. Main clinical outcomes are summarised in table 1. Conclusion The implementation of an early-oral antimicrobial switch protocol in the pneumology ward is effective and safe. The early-oral antibiotic switch could decrease the days of catheterisation and the potential related adverse outcomes, with a shortening in the length of stay. References and/or acknowledgements None. No conflict of interest.

Background The incidence of Enterococcus faecium infections has increased over the past years and is currently the third major microorganism implicated in nosocomial bacteraemia. Nevertheless, the best treatment available is yet to be established, especially in vancomycin-susceptible E. faecium . In this setting, a correct dosage is essential, as inappropriate dosage has been associated with a higher risk of treatment failure. Purpose Our objective was to describe the dosage adequacy of antibiotics used in the treatment of E. faecium bacteraemia. Material and methods Retrospective observational study performed in a 400-bed university teaching hospital from June 2011 to June 2016. Patients with E. faecium isolation from at least one positive blood culture were included. Dosage adequacy was assessed by infectious-diseases-trained pharmacists, who reviewed antimicrobial prescriptions daily and recommended an appropriate dose adjustment in the first 24 to 72 hours of treatment. Inappropriate dosage was considered if it was out of therapeutic range according to plasmatic levels when available, or if an adjustment was needed according to weight or renal function (based on John Hopkins antibiotic guide and data sheet). Categorical variables were presented as percentages and continuous variables as mean (±SD). Results Seventy patients were included Sixty (85.7%) males, 17 (24.3%) critically ill, mean age 69.8 (±13.5) years. Thirty (42.3%) patients received an inappropriate dosage, 19 (63.3%) of them were underdosed. Conclusion Almost 43% of patients were inappropriately dosed in E. faecium bacteraemia, mainly because of underdosing. These data demonstrate the large proportion of inappropriate doses, which highlights the importance of an adequate review of medication and therapeutic drug monitoring in order to assure efficacy and prevent toxicities. No conflict of interest