Early Transition to Oral Therapy in Gram-Negative Bloodstream Infections: What is the Next Step?

Traditionally, gram-negative bloodstream infections (GN-BSI) have been treated with intravenous (IV) therapy throughout the entire treatment course. Recent studies support the effectiveness and safety of transitioning stable GN-BSI patients to oral antibiotics after IV treatment [ 1 Amodio-Groton M. Madu A. Madu C.N. Briceland L.L. Seligman M. McMaster P. et al. Sequential parenteral and oral ciprofloxacin regimen versus parenteral therapy for bacteremia: A pharmacoeconomic analysis. Ann Pharmacother. 1996; 30: 596-602https://doi.org/10.1177/106002809603000605 Crossref PubMed Scopus (61) Google Scholar , 2 Monmaturapoj T. Montakantikul P. Mootsikapun P. Tragulpiankit P. A prospective, randomized, double dummy, placebo-controlled trial of oral cefditoren pivoxil 400mg once daily as switch therapy after intravenous ceftriaxone in the treatment of acute pyelonephritis. Int J Infect Dis. 2012; 16: e843-e849https://doi.org/10.1016/j.ijid.2012.07.009 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar , 3 Park T.Y. Choi J.S. Song T.J. Do J.H. Choi S.H. Oh H.C. Early Oral Antibiotic Switch Compared with Conventional Intravenous Antibiotic Therapy for Acute Cholangitis with Bacteremia. Dig Dis Sci. 2014; 59: 2790-2796https://doi.org/10.1007/s10620-014-3233-0 Crossref PubMed Scopus (29) Google Scholar , 4 Tamma P.D. Conley A.T. Cosgrove S.E. Harris A.D. Lautenbach E. Amoah J. et al. Association of 30-Day Mortality with Oral Step-Down vs Continued Intravenous Therapy in Patients Hospitalized with Enterobacteriaceae Bacteremia. JAMA Intern Med. 2019; 179: 316-323https://doi.org/10.1001/jamainternmed.2018.6226 Crossref PubMed Scopus (77) Google Scholar , 5 Omrani A.S. Abujarir S.H. Abid F.B. Shaar S.H. Yilmaz M. Shaukat A. et al. Switch to Oral Antibiotics in Gram-negative Bacteraemia; a Randomised, Open-label, Clinical Trial. Clin Microbiol Infect. 2023 Oct 17; (S1198-743X(23)00522-0)https://doi.org/10.1016/j.cmi.2023.10.014 Abstract Full Text Full Text PDF Scopus (0) Google Scholar ]. This shift offers advantages by allowing patients to return to their baseline condition, preventing catheter-related adverse effects, and reducing the carbon footprint of clinical care [ 6 Keller S.C. Dzintars K. Gorski L.A. Williams D. Cosgrove S.E. Antimicrobial Agents and Catheter Complications in Outpatient Parenteral Antimicrobial Therapy. Pharmacotherapy. 2018; 38: 476-481https://doi.org/10.1002/phar.2099 Crossref PubMed Scopus (26) Google Scholar , 7 Eii MN, Walpole S, Aldridge C. Sustainable practice : Prescribing oral over intravenous medications 2023:10–12. doi:10.1136/bmj-2023-075297. Google Scholar , 8 Tamma P.D. Cosgrove S.E. Which trial do we need? Early oral antibiotic therapy for the treatment of gram-negative bloodstream infections. Clin Microbiol Infect. 2023; 29: 670-672https://doi.org/10.1016/j.cmi.2023.02.012 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar ]. It can also improve the overall patient experience. However, challenges remain, including defining patient criteria selection, optimal timing, specifying the clinical conditions suitable for this transition, and selecting the appropriate oral antibiotics. Switch to oral antibiotics in Gram-negative bacteraemia: a randomized, open-label, clinical trialClinical Microbiology and InfectionPreviewTo evaluate the safety and efficacy of switching from intravenous (IV) to oral antimicrobial therapy in patients with Enterobacterales bacteraemia, after completion of 3–5 days of microbiologically active IV therapy. Full-Text PDF