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Intravenous to oral antibiotic switch therapy
1Chief, Infectious Disease Division, Winthrop-University Hospital, Mineola, New York and Professor of Medicine, State University of New York School of Medicine, Stony Brook, New York, USA.
Drugs of Today (Barcelona, Spain : 1998)
|May 28, 2003
Summary
Intravenous-to-oral (i.v.-to-p.o.) switch therapy is ideal for most hospitalized patients, offering cost savings and reduced complications. This approach is suitable for all but the most critically ill or those with absorption issues, promoting efficient antibiotic treatment.
Area of Science:
- Pharmacology
- Infectious Diseases
- Clinical Pharmacy
Background:
- Intravenous-to-oral (i.v.-to-p.o.) switch therapy is a standard practice in antibiotic treatment for many patients.
- This strategy involves transitioning patients from intravenous to oral antibiotic formulations when clinically appropriate.
- Exceptions to this therapy include critically ill patients requiring continuous i.v. treatment and those with impaired oral absorption.
Purpose of the Study:
- To evaluate the suitability and benefits of i.v.-to-p.o. switch therapy in hospitalized patients.
- To identify ideal antibiotic agents for successful i.v.-to-p.o. switch programs.
- To emphasize the broad applicability of oral antibiotic therapy beyond specific infectious diseases.
Main Methods:
- Review of clinical guidelines and antibiotic properties relevant to i.v.-to-p.o. switch therapy.
- Identification of antibiotics with high bioavailability and favorable pharmacokinetic profiles for oral administration.
- Analysis of patient populations where i.v.-to-p.o. switch therapy is appropriate, considering critical illness and absorption capacity.
Main Results:
- Antibiotics such as chloramphenicol, clindamycin, fluoroquinolones, and azoles are well-suited for i.v.-to-p.o. switch due to high bioavailability.
- Beta-lactams and macrolides can be used despite lower bioavailability, and alternative oral agents are available for non-oral formulations like carbapenems.
- Oral absorption is generally preserved in most hospitalized patients, even those who are ill, making oral therapy feasible.
Conclusions:
- I.v.-to-p.o. switch therapy is appropriate for the vast majority of hospitalized patients, excluding the critically ill and those with malabsorption.
- This therapeutic approach offers significant advantages, including reduced drug costs, shorter hospital stays, and decreased risks of i.v. line complications.
- Clinicians should widely consider oral antibiotics for most or all of a patient's treatment course when effective oral options exist.