What are special concerns in 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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Answer

Answer

According to Wilcox, less obvious potential benefits of sequential antimicrobial therapy include fewer intravascular catheter infections because of shorter line-dwell times and less endoluminal contamination. [55] Sequential antimicrobial therapy may also be used as part of a policy to reduce the selective pressure, particularly due to cephalosporin use, for endemic hospital pathogens such as C difficile and extended-spectrum–producing gram-negative bacilli.

Caceres et al found that an in-hospital observation period after a patient is changed to oral treatment is of limited usefulness. In this study, only 1% of patients had evidence of clinical relapse within the study period. Four percent of patients had adverse reactions to their oral antibiotic, none of which was serious. Thus, discharging patients after changing to oral antibiotics could result in savings from avoiding an extra day of hospitalization, amounting to millions of dollars annually in the United States. [56]

A 2010 case report noted elevated tacrolimus levels associated with intravenous azithromycin and ceftriaxone. After the ceftriaxone was discontinued and the intravenous azithromycin was switched to an oral dose, the tacrolimus levels returned to previous levels. [57]


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