Sequential antibiotic therapy: the right patient, the right time and the right outcome.

The aim of sequential therapy should be to provide better quality of care at lower cost. In comparison with i.v. therapy, oral administration is safer, more acceptable to the patient, facilitates early discharge from hospital and reduces the cost of consumables. However, if given to the wrong patient, oral antimicrobial therapy could both increase the cost and reduce the quality of care, either because of ineffective treatment, or unnecessary prolongation of treatment. Hospitals must develop policies for sequential therapy which define standards against which clinical care can be audited. The standards will need to be revised as new data become available from local audit and from research. Further research on sequential therapy is undoubtedly required, with particular emphasis on the reliability of absorption of oral drugs by hospitalized patients.