Which antibiotic therapies are options for intravenous-to-oral switch therapy?

Updated: Jul 30, 2018
  • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Switch therapy is possible with various oral antibiotics. Antibiotics ideal for intravenous-to-oral (IV-to-PO) switch programs include chloramphenicol, clindamycin, metronidazole, trimethoprim-sulfamethoxazole, fluconazole, itraconazole, voriconazole, doxycycline, minocycline, levofloxacin, moxifloxacin, and linezolid. [25]

Sequential antibiotic therapy ensures an early switch to the oral route when a patient is clinically stable. This increasingly used strategy is safe and improves the quality and cost-effectiveness of health care. Timely and appropriate switch therapy must be underpinned by clear guidelines and supported by a multidisciplinary team. According to some authorities, approximately 40% of patients starting on intravenous antibiotics are candidates for a switch to oral antibiotics after 2-3 days of therapy.

In 2004, Vogtlander et al, at the Department of General Internal Medicine, University Medical Center Nijmegen, in the Netherlands, involved the departments of internal medicine, surgery, and neurology and the emergency department at a tertiary referral university medical center in a study of all consecutive patients receiving therapeutic antibiotics. Dosages, timing of first doses, dosing intervals, administration routes, and adjustment of the chosen drug to clinical data were investigated. After the preintervention period, barriers to change were identified, followed by specific interventions and a postintervention measurement. In the preintervention and postintervention periods, 247 and 250 patients were enrolled, receiving 563 and 598 antibiotic prescriptions, respectively. [26]

The mean time from the order to first dose at the wards improved from 2.7 to 1.7 hours in potentially severe cases (P = .003). Dosage adjustment per renal function remained unchanged at 45% versus 52% (P = .09) of cases when necessary. Switching of therapy from an intravenous route to an oral route improved from 46% to 62% (P = .03) and was performed a mean of 1.6 days earlier (P = .002). Streamlining was performed correctly in most cases; thus, no interventions were necessary. Timing of antibiotic therapy and switch therapy may be improved with a combination of interventions. Other strategies are needed to improve the poor adjustment of dosing per renal function. In this study, streamlining was already correct in most cases. [26]

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