![]() 9 Without the appropriate physical measures to remove, debride, or amputate the affected area(s), the use of any antibiotics (IV or oral) is inconsequential. ![]() Source Control: For all patients undergoing treatment for infection, adequate source control is paramount. ![]() TABLE 1 illustrates the three main types. 4 However, there are several factors to consider and follow when approaching the conversion of a patient from IV to oral therapy while treating BSI. Assessing the Appropriateness of IV to Oral Conversion of Antibioticsįor many medications, the bioavailability of the oral formation is comparable if not equal to that of their IV counterpart. However, the practicality of oral therapy must be assessed carefully with each patient based on the organism, pharmacokinetics, patient factors (such as drug allergies and ability to take oral medications), clinical stability, and available evidence. Oral antimicrobial therapy for BSI, when appropriate, not only meets the recommendations of these organizations, but it also provides reductions in patient and healthcare costs and complications while providing noninferior outcomes. Essential AMS principles set forth by the CDC include the use of the shortest length of antibiotic treatment and decreasing utilization of broad-spectrum antimicrobials. 5 The organization recommends that providers “prefer oral formulations of highly bioavailable antimicrobials whenever possible.” This and several other initiatives by organizations such as the CDC and World Health Organization have launched the implementation of antimicrobial stewardship (AMS) programs and research to prevent further overuse of antimicrobials and antibiotic resistance. In 2012, the American Board of Internal Medicine Foundation launched the “Choosing Wisely” campaign aimed to promote practice changes to improve patient health and safety by avoiding unnecessary diagnosis and treatments. 3,4 The at-home utilization of these devices also increases the risks of complications associated with patient errors in their appropriate care and management. Prolonged catheter placement can cause numerous complications, including infection, thrombosis, and device dysfunction. However, the clinically stable patient may benefit from partial or complete oral antibiotics by improving their mobility, reducing the risk of IV catheter–related infections and discomfort, as well as reducing healthcare costs. This mantra is indeed warranted in acutely ill patients, such as those with sepsis, as timely IV antibiotics can be lifesaving. 1 IV antibiotics are generally thought to be the mainstay of treatment for BSIs with their high bioavailability and fast peak plasma levels. Oral therapy offers several benefits with similar outcomes, and the decision to treat a patient with oral antibiotics should be based on current evidence as well as patient, pathogen, and drug characteristics.īacterial bloodstream infections (BSIs) are a considerable cause of morbidity and mortality, with nearly 30 million cases worldwide each year resulting in 6 million deaths and insurmountable costs. Associated costs and risks with IV agents make them less than ideal in many infectious diseases, including bacteremia. However, the ideal route of administration of any medication is one that achieves serum concentrations sufficient to produce the desired result without any unwanted effects. ABSTRACT: IV antibiotics are generally thought to be the mainstay of treatment for bloodstream infections due to their high bioavailability and fast peak plasma levels.
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