A Multicenter Retrospective Study Evaluating Intravenous to Oral Antibiotic Stepdown for Uncomplicated Streptococcal...

Area of Science:

• Infectious Diseases
• Pharmacology
• Clinical Medicine

Background:

• Streptococcal bacteremia is a serious infection requiring effective treatment.
• Intravenous (IV) therapy is standard, but oral (PO) stepdown may offer advantages.

Purpose of the Study:

• To compare the efficacy and safety of IV versus PO stepdown antibiotic therapy for uncomplicated streptococcal bacteremia.

Main Methods:

• Retrospective multicenter study of adult patients with uncomplicated streptococcal bacteremia (2019-2022).
• Comparison of patients receiving full IV therapy versus those transitioning to PO stepdown after initial IV treatment.
• Primary outcome: clinical success at 90 days (no recurrence, readmission, or mortality).

Main Results:

• Clinical success rates were similar: 94.4% (IV only) vs. 94.6% (PO stepdown).
• PO stepdown group had significantly shorter length of stay (5.5 vs. 9.2 days).
• Fewer line complications in the PO stepdown group (0% vs. 7.2%).

Conclusions:

• Oral stepdown therapy is a viable option for uncomplicated streptococcal bacteremia, offering similar clinical success to IV-only therapy.
• PO stepdown can reduce length of stay and IV line-associated complications.
• Consider PO stepdown in select patients after initial IV treatment, considering clinical factors.