Home Gastrointestinal ID physicians prefer oral antibiotics for treatment of patients with bacteremia

ID physicians prefer oral antibiotics for treatment of patients with bacteremia

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Duane R. Hospenthal, MD, PhD

Duane R. Hospenthal

A survey among members of the Infectious Diseases Society of America’s Emerging Infection Network showed that the majority of adult infectious disease physicians would shift patients with both gram-negative and gram-positive bacteremia to oral antibiotics for treatment.

In addition, most agreed that oral agents could be used for gram-negative bacteremia caused by Enterobacteriaceae, but would not use oral agents for gram-positive bacteremia caused by Staphylococcus aureus or for endocarditis.

“IDSA Emerging Infections Network (EIN) studies are prompted by input, ideas and questions from EIN participants and others working in infectious diseases,” Duane R. Hospenthal, MD, PhD, adjunct professor of medicine in the Division of Infectious Diseases at the University of Texas Health Science Center, told Infectious Disease News. “This study was prompted by an initial inquiry by Dr. C. Dustin Waters and was moved forward by EIN chiefly to investigate [and] document how ID physicians were using IV vs. oral antibiotics in the treatment of patients with bacteremias, as there is essentially no guidance for this topic in the form of randomized clinical trials (RCTs).”

Adult infectious disease (ID) physicians participating in the IDSA EIN were surveyed about their use of oral antibiotics in patients with bacteremia. Individuals responding to the survey were told to assume that patients were hemodynamically stable, recovered bacteria were susceptible to potential antibiotics and that patients had sufficient gastrointestinal absorption. They were also asked to assume that participants had attained adequate source control.

In total, researchers received responses from 655 EIN participants. Data collected from the survey showed that, under certain conditions, 88% would transition patients with gram-negative bacteremia to oral antibiotics, 71% would transition patients with gram-positive bacteremia to oral agents and 12% of respondents wouldn’t treat any patient with bacteremia with oral agents. Additionally, more than 75% of respondents were comfortable treating infections secondary to Enterobacteriaceae, Salmonella, Pseudomonas, Stenotrophomonas, Streptococcus pneumoniae and beta-hemolytic streptococci with oral agents; fewer than 20% supported the use of oral antibiotics for Staphylococcus aureus or endocarditis.

Fluoroquinolones and trimethoprim-sulfamethoxazole were the agents selected by survey respondents for gram-negative bacteremia. Linezolid and beta-lactams were preferred for gram-positive bacteremia.

“The key findings are that, in certain situations, ID physicians do feel comfortable transitioning patients to oral antibiotics to complete a course of therapy for bacteremia. This was true for gram-negative and gram-positive bacteremia, but not for the treatment of S. aureus bacteremia or endocarditis due to either gram-negative or gram-positive bacteria,” Hospenthal said. “Transition to oral antibiotics to complete a course of therapy in patients with bacteremia, other than those associated with endocarditis or due to S. aureus, has acceptance by the ID community, but further RCTs to define patient selection, antibiotic selection and when to transition are needed.” – by Caitlyn Stulpin

Disclosure: Hospenthal reports no relevant financial disclosures.

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