What are the median thresholds at which a typical patient can undergo intravenous-to-oral switch therapy?

Updated: Jul 30, 2018
  • Author: Shirin A Mazumder, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

Fifty-eight percent of physicians believed that "patients should be afebrile for 24 hours before conversion to oral antibiotics," and 19% said "patients should receive a standard duration of intravenous antibiotics." The median thresholds at which physicians believed a typical patient could be converted to oral therapy were as follows [50] :

  • Temperature of less than or equal to 100°F (37.8°C)

  • Respiratory rate of less than or equal to 20 breaths per minute

  • Heart rate of less than or equal to 100 beats per minute

  • Systolic blood pressure of 100 mm Hg or higher

  • Room air oxygen saturation of 90% or higher

In univariate analyses, pulmonary and infectious disease physicians were the most predisposed toward early conversion to oral antibiotics, and other medical specialists were the least predisposed, with generalists being intermediate (P< .019). In multivariate analyses, practice beliefs were associated with age, inpatient care activities, attitudes about guidelines, and agreeableness on a personality inventory scale. In summary, physicians believed that patients could be switched to oral antibiotics once vital signs and mental status had stabilized and oral intake was possible. However, antibiotic practice beliefs varied considerably. [50]


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