Oral Antibiotic Therapy of Serious Systemic Infections
Section snippets
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
References (110)
- et al.
Oral antibiotic treatment of infectious diseases
Med Clin North Am
(2001) - et al.
A prospective randomized study of inpatient intravenous antibiotics for community-acquired pneumonia: the optimal duration of therapy
Chest
(1996) Bacillus anthracis and antibacterial agents
Clin Microbiol Infect
(2002)- et al.
Epidemiological and diagnostic aspects of the outbreak of pneumonic plague in Madagascar
Lancet
(2000) Community-acquired pneumonias: reality revisited
Am J Med
(2000)Oral or intravenous-to-oral antibiotic switch therapy for treating patients with community-acquired pneumonia
Am J Med
(2001)- et al.
Sequential IV/PO moxifloxacin treatment of patients with severe community-acquired pneumonia
Respir Med
(2003) - et al.
Doxycycline activity against Streptococcus pneumoniae
Chest
(1995) - et al.
Doxycycline use for community-acquired pneumonia: contemporary in vitro spectrum of activity against Streptococcus pneumoniae (1999–2002)
Diagn Microbiol Infect Dis
(2004) - et al.
Telithromycin 800 mg once daily for seven to ten days is an effective and well-tolerated treatment for community-acquired pneumonia
Clin Microbiol Infect
(2003)
Activity of telithromycin against erythromycin-susceptible and resistant Streptococcus pneumoniae is from adults with invasive infections
Int J Antimicrob Agents
Activity of telithromycin against key pathogens associated with community-acquired respiratory tract infections
J Infect
A review of clinical failures associated with macrolide-resistant Streptococcus pneumoniae
Int J Antimicrob Agents
Empiric therapy of community-acquired pneumonia: guidelines for the perplexed?
Chest
Nosocomial pneumonia. Diagnostic and therapeutic considerations
Med Clin North Am
Causes of fever and pulmonary densities in patients with clinical manifestations of ventilator-associated pneumonia
Chest
Association between Staphylococcus aureus strains carrying genes for Panton-Valentine leukocidin and highly lethal necrotizing pneumonia in young immunocompetent patients
Lancet
Spread of Staphylococcus aureus clinical isolates carrying Panton-Valentine leukocidin genes during a 3-year period in Greece
Clin Microbiol Infect
The emergence of infections with community-associated methicillin-resistant Staphylococcus aureus
J Infect
Community-acquired methicillin-resistant Staphylococcus aureus: current perspectives
Clin Microbiol Infect
Acute infective endocarditis
Infect Dis Clin North Am
Antistaphylococcal (MSSA, MRSA, MSSE, MRSE) antibiotics
Med Clin North Am
Methicillin-resistant Staphylococcus aureus: clinical manifestations and antimicrobial therapy
Clin Microbiol Infect
Oral antibiotics to treat MRSA infections
J Hosp Infect
Intravenous to oral antibiotic switch therapy
Drugs Today
Oral antibiotics practical prescribing rules for practitioners
Geriatrics
The intestinal absorption of oral antibiotics in traumatic shock; an experimental study
Surg Gynecol Obstet
Pharmacokinetics of drugs used in critically ill adults
Clin Pharmacokinet
Pharmacokinetics of a clarithromycin suspension administered via nasogastric tube to seriously ill patients
Antimicrob Agents Chemother
Distribution of metronidazole in muscle tissue of patients with septic shock and its efficacy against Bacteroides fragilis in vitro
J Antimicrob Chemother
The pharmacokinetics of metronidazole and its metabolites in critically ill patients
J Antimicrob Chemother
Single-dose pharmacokinetics of oral fleroxacin in bacteremic patients
Antimicrob Agents Chemother
Pharmacokinetics of intravenous and oral levofloxacin in critically ill adults in a medical intensive care unit
Pharmacotherapy
Levofloxacin PK/PD: from sequential therapy model to high dosage for critical patients
J Chemother
Pharmacokinetics of pefloxacin and amikacin administered simultaneously to intensive care patients
Eur J Clin Pharmacol
Transitional antibiotic therapy
Infect Dis Clin Practice
Intravenous ceftriaxone compared with oral doxycycline for the treatment of Lyme neuroborreliosis
Scand J Infect Dis
Minocycline vs. doxycycline for the antimicrobial therapy of Lyme neuroborreliosis
Clin Infect Dis
Gentamicin and tetracyclines for the treatment of human plague review of 75 cases in New Mexico, 1985–1999
Clin Infect Dis
Treatment of plague with gentamicin or doxycycline in a randomized clinical trial in Tanzania
Clin Infect Dis
Laboratory studies on Yersinia pestis during the 1991 outbreak of plague in Lushoto, Tanzania
J Trop Med Hyg
A randomized, double-blind study to assess the optimal duration of doxycycline treatment for human brucellosis
Clin Infect Dis
Pharmacokinetics of oral doxycycline during combination treatment of severe falciparum malaria
Antimicrob Agents Chemother
Linezolid
Drugs
Minocycline
Ther Drug Monit
Current and future perspectives for levofloxacin in severe Pseudomonas aeruginosa infections
J Antimicrob Chemother
Cited by (45)
Complex Foot Infection Treated With Surgical Debridement and Antibiotic Loaded Calcium Sulfate—A Retrospective Cohort Study of 137 Cases
2022, Journal of Foot and Ankle SurgeryEarly switch/early discharge opportunities for hospitalized patients with methicillin resistant Staphylococcus aureus complicated skin and soft tissue infections: Saudi Arabia and United Arab Emirates
2020, Journal of Infection and Public HealthCitation Excerpt :There are several PO therapies with activity against MRSA cSSTIs; however, an increase in MRSA isolates resistance requires that local susceptibility data be used to guide the choice of therapy for a patient. Tolerability, bioavailability, and efficacy in patients with complicated disease should also be considered [8,15]. Additionally, patients should be able to tolerate oral food or fluids so that the anticipation of poor absorption can be ruled out [16].
The Pharmacoeconomic Aspects of Antibiotic Stewardship Programs
2018, Medical Clinics of North AmericaAntibiotic Stewardship Program Perspective: Oral Antibiotic Therapy for Common Infectious Diseases
2018, Medical Clinics of North AmericaCitation Excerpt :Advantages of the oral portion of IV-to-oral switch therapy includes lower drug costs, no phlebitis, increased patient satisfaction, no peripherally inserted central catheter lines (with their associated complications of bacteremia, fungemia), earlier discharge, and decreased length of stay (LOS)11–16 (Table 1). If IV-to-oral switch is good, then entirely oral therapy is even better.2–5 Sometimes medical practice needs prompting, and the Centers for Disease Control and Prevention’s mandated antibiotic stewardship programs (ASPs) have provided the impetetus.17–19
Retrospective analysis comparing oral stepdown therapy for enterobacteriaceae bloodstream infections: fluoroquinolones versus β-lactams
2018, International Journal of Antimicrobial AgentsAntimicrobial Therapy for Legionnaire's Disease: Antibiotic Stewardship Implications
2017, Infectious Disease Clinics of North America