In which conditions is intravenous-to-oral switch therapy beneficial?

Updated: Jul 30, 2018
  • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Other uses of switch therapy can include the treatment of spontaneous bacterial peritonitis. A more cost-effective switch therapy in the treatment of spontaneous bacterial peritonitis in patients with cirrhosis who are not receiving prophylaxis with quinolones involves the use of a cephalosporin rather than intravenous ceftazidime. [21]

In a study of 169 cases of septic arthritis in 157 adults, 12% recurred after intravenous to oral switch. Gram-negative bacteria, immunosuppression, and lack of surgical clearance of the nidus of infection complicated the switch. In most cases, 7 days of intravenous therapy was similar in outcome to 8-21 days. Fourteen days or less has the a similar outcome as 15-28 days or more than 28 days. [22]

In a study of 82 patients with putative pyelonephritis, [23] all received 2 g of intravenous ceftriaxone initially. After day 3, they were split into 2 groups of 41 one receiving 2 g of intravenous ceftriaxone and the other a single daily dose of oral cefditoren pivoxil at 400 mg. Ninety-five percent of the orally treated patients and 100% of those receiving intravenous therapy achieved a clinical cure, with 63.4% of the oral and 60% of the intravenous groups treated achieving bacteriological eradication; no difference was noted in adverse effects between the 2 groups. The authors conclude that this switch is viable, even though the pathogens of pyelonephritis are often quinolone-resistant. Perihepatitis and accute pelvic inflammatory disease treated with intravenous azithromycin switched to oral azithromycin

has been found effective and practical in Japan. [24]

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