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Current Infectious Disease Reports

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31-10-2023 | Antibiotic | Antimicrobial Development and Drug Resistance (KC Claeys and J Smith, Section Editors)

One Small Step (Down) for Antibiotics, One Giant Leap for Outpatient Therapy: The Role of Oral Antibiotics in Serious Bacterial Infections

Authors: Jessica K. Ortwine, Wenjing Wei, Norman S. Mang, Brenton C. Hall, Helen Ding

Published in: Current Infectious Disease Reports | Issue 12/2023

Abstract

Purpose of Review

Stepping down to oral antibiotic therapy after a period of IV lead-in would eliminate most of the untoward effects of long-term intravenous therapy, including lengthy hospital admissions, copays for ambulatory infusions, catheter-related adverse events, and missed work/school.

Recent Findings

Two randomized, controlled trials, POET and OVIVA, contribute significant support for oral stepdown regimens in endocarditis and osteomyelitis, disease states that are commonly caused by gram-positive organisms. In addition, a number of retrospective reviews comparing early oral switch to continued IV therapy for bacteremia due to Streptococcus and Enterobacterales have shown no significant differences in morality, re-infection, or re-admission. Optimal oral antibiotic selection has been reviewed in a number of studies for gram-negative bacteremia, but similar data is lacking for gram-positive infections.

Summary

Stepdown to oral antibiotic therapy is a safe, effective, and cost-saving method of treating a range of bacterial infections, especially with highly bioavailable antibiotics. Less bioavailable antibiotics (i.e., β-lactams) may also be effective, but data supporting optimal agent selection and dosing regimens is needed.

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Title: One Small Step (Down) for Antibiotics, One Giant Leap for Outpatient Therapy: The Role of Oral Antibiotics in Serious Bacterial Infections
Authors: Jessica K. Ortwine
Wenjing Wei
Norman S. Mang
Brenton C. Hall
Helen Ding
Publication date: 31-10-2023
Publisher: Springer US
Keywords: Antibiotic
Endocarditis
Osteomyelitis
Streptococci
Published in: Current Infectious Disease Reports / Issue 12/2023
Print ISSN: 1523-3847
Electronic ISSN: 1534-3146
DOI: https://doi.org/10.1007/s11908-023-00823-7

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