A sticker reminder intervention to promote intravenous-to-oral fluoroquinolone conversion: a cluster-randomized controlled trial

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OBJECTIVE: To evaluate the effectiveness of a simple sticker reminder in increasing intravenous-to-oral (IV-to-PO) fluoroquinolone (FQ) conversion rates. DESIGN: Single-center, cluster-randomized controlled trial. SETTING: Forty-five general wards at Siriraj Hospital, Bangkok, Thailand, from July 2020 through December 2024. PATIENTS: Hospitalized adult patients receiving intravenous fluoroquinolones who met predefined IV-to-PO conversion criteria. METHODS: Wards were randomized 1:1 to either a sticker reminder intervention or standard care. In the intervention group, a reminder sticker was placed on the vital signs sheet of eligible patients. The primary outcome was the proportion of IV-to-PO conversion in the intention-to-treat (ITT) and modified intention-to-treat (mITT) populations. RESULTS: A total of 168 patients were enrolled (85 intervention, 83 control). In the ITT population, the IV-to-PO conversion rate was 58.8% in the intervention group versus 42.2% in the control group (p-value = 0.03). In the mITT population (patients meeting all conversion criteria), the intervention group had a significantly higher conversion rate (69.0% vs. 48.5%; p-value = 0.01). No significant differences were observed in clinical cure rates, in-hospital mortality, length of stay, duration of either IV FQ or PO FQ therapy. CONCLUSION: A sticker reminder intervention effectively increases IV-to-PO FQ conversion among eligible patients without compromising clinical safety. Future large-scale and qualitative studies are needed to further validate these benefits and explore prescriber hesitation. TRIAL REGISTRATION: ClinicalTrials.gov NCT07361185 (retrospectively registered on 22 January 2026).

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