Oral Antibiotic Therapy of Serious Systemic Infections

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Antibiotic bioavailability

Bioavailability is a key determinant in selecting an antibiotic for oral therapy. Orally administered antibiotics may be divided into three categories based upon their oral bioavailability. In the first category are antibiotics that are not well absorbed and have low bioavailability, making them unsuitable oral agents for use in serious systemic infections. Some of these antimicrobials are not well absorbed orally, and concentrate in particular compartments/body fluids, making them useful for

Advantages of oral antibiotic therapy

The use of entirely oral antibiotic therapy for serious systemic infections has increased slowly over time. Some physicians still have difficulty conceptually switching from IV therapy to IV to PO switch therapy. Expectedly, if one is not an infectious disease clinician with expertise in antimicrobial therapy, there remains some reluctance to rely solely on PO therapy for therapy of serious systemic infections. Over time, as familiarity and experience has been accrued, there has been a gradual

Serious infections traditionally treated with oral antibiotics

Because there is virtually no difference between PO and IV therapy, there are important pharmacoeconomic and clinical reasons to rely more on PO therapy for most infectious diseases including serious systemic infections. The serious systemic infectious diseases that readily lend themselves to treatment entirely via the oral route, or less desirably but acceptably as part of an IV to PO switch regimen, include febrile neutropenia, severe CAP requiring hospitalization,

Factors in oral antibiotic selection

Therapeutically, the selection of an oral antibiotic may conveniently be considered as being in two categories, that is, in those where equivalent IV and PO formulations exist that have a high bioavailability and an appropriate spectrum for the treatment of infection, and the other group of all antibiotics that have good bioavailability and are equivalent in spectrum to IV antibiotics that have no PO formulation. For these patients, the clinician must select and IV equivalent PO antibiotic

Summary

As more experience and confidence is gained in using oral antimicrobial therapy in a wide variety of infections particularly in those with serious systemic infectious diseases, the relative use of parenteral antibiotic therapy will continue to decline. IV antibiotic therapy will continue to have an important role in the initial therapy of critically ill patients, in those with inadequate proximal gastrointestinal absorptive capability, and in those for which no oral equivalent antibiotic is

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