Oral or intravenous antibiotics?

Abstract

Intravenous antibiotics are overused in hospitals. Many infections can be managed with oral antibiotics.Oral antibiotics avoid the adverse effects of intravenous administration. They are also usually less expensive.When intravenous antibiotics are indicated, it may be possible to switch to oral therapy after a short course. There are guidelines to aid the clinician with the timing of the switch so that there is no loss of efficacy.Infections that may be suitable for a short course of intravenous antibiotic include pneumonia, complicated urinary tract infections, certain intra-abdominal infections, Gram-negative bacteraemia, acute exacerbations of chronic lung disease, and skin and soft tissue infections.Bone and joint infections and infective endocarditis are managed with prolonged courses of intravenous antibiotics. However, there is research looking at the feasibility of an earlier switch to oral antibiotics in these conditions. third of almost 2000 days of antibiotic therapy was unnecessary. 3 Using oral rather than parenteral antibioticsMajor advantages of oral over the intravenous route are the absence of cannula-related infections or thrombophlebitis, a lower drug cost, and a reduction in hidden costs such as the need for a health professional and equipment to administer intravenous antibiotics. Oral therapy may potentially enable an early discharge from the hospital 4,5 or directly from the emergency department. 6 For example, a single dose of intravenous antibiotic for paediatric uncomplicated urinary tract infections did not reduce the rate of representation or readmission. This suggests most children with a urinary tract infection can be managed with oral antibiotics alone. 7 A key consideration is the bioavailability of oral antibiotics. This varies in comparison to intravenous formulations (Tables 1 and 2). Some oral antibiotics have equivalent bioavailability to the intravenous drug. They could be substituted, depending on the condition being treated and the required site of drug penetration.In a small prospective trial, patients with moderately severe cellulitis were randomised to receive either oral cefalexin monohydrate or parenteral cefazolin. Parenteral administration was changed to oral once the cellulitis had stopped progressing and the patient was afebrile. There was no statistically significant REFERENCES

Principles of empiric antimicrobial usage and dosing: Lessons learned

“…1 The benefits of employing a highly bioavailable oral agent over its intravenous counterpart include decreased time needed for preparation and administration, reduction in intravenous line-associated complications (including infections and thrombophlebitis), decreased cost of health professionals needed to administer the drug, and early discharge from a treatment facility. 4 By utilizing intravenous clindamycin, our patient was required to attend the hospital daily, a relevant impediment to her ability to attend work and generate income, particularly when an oral equivalent was available. Importantly, her intravenous clindamycin was not dosed thrice daily owing to the inability to facilitate multiple visits per day for parenteral antimicrobial therapy, therefore rendering it potentially ineffective.…”

Pharmaceutical Approaches on Antimicrobial Resistance: Prospects and Challenges

“…Oral administration has been known as the safest and most convenient route for any medication, especially for antimicrobials. The oral route is preferable for antibiotic treatment over the intravenous route due to several advantages, such as being cheap, easy to administer, and not requiring any healthcare professional intervention due to the absence of a needle during the treatment [ 179 , 180 ]. Oral antibiotics can be considered the first option to treat any non-emergency condition over other routes if the bioavailability is over 90% compared to the intravenous route [ 180 ].…”

“…The oral route is preferable for antibiotic treatment over the intravenous route due to several advantages, such as being cheap, easy to administer, and not requiring any healthcare professional intervention due to the absence of a needle during the treatment [ 179 , 180 ]. Oral antibiotics can be considered the first option to treat any non-emergency condition over other routes if the bioavailability is over 90% compared to the intravenous route [ 180 ]. Therefore, bioavailability becomes a significant concern for the scientist in designing and developing antibiotic formulations for oral administration.…”

Systematic review: the bioavailability of orally administered antibiotics during the initial phase of a systemic infection in non-ICU patients

“…Guidelines recommend to switch to oral therapy only when the patient has been treated intravenously (IV) for at least 48–72 h and in case the clinical condition has improved and the fever has abated [ 1 ]. The question is whether or not patients can be switched to oral antibiotics earlier than 48 h, which recently has become subject of debate [ 2 , 3 ]. Switching to oral therapy has been shown to lower the length of hospital stay, the risk of new infections and healthcare costs, without compromising clinical outcome [ 4 ].…”