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

Abstract

Background The systemic response to an infection might influence the pharmacokinetics of antibiotics. To evaluate the desired possibility of an earlier (< 24 h) IV-to-oral switch therapy in febrile non-ICU, hospitalized patients, a systematic review was performed to assess the effect of the initial phase of a systemic infection on the bioavailability of orally administered antibiotics in such patients. Methods An electronic search was conducted in MEDLINE and Embase up to July 2020. Studies were selected when outcome data were collected during the initial stage of a febrile disease. Outcome data were (maximum) serum concentrations, time of achieving maximum serum concentration, and the area-under-the-plasma-concentration-time curve or bioavailability of orally administered antibiotics. Risk of bias was assessed. Results We identified 9 studies on 6 antibiotics. Ciprofloxacin was the most frequently studied drug. Outcomes of the studies were heterogeneous and generally had a high risk of bias. Three small studies, two on ciprofloxacin and one on clarithromycin, compared the pharmacokinetics of febrile patients with those of clinically recovered patients and suggested that bioavailability was not altered in these patients. Other studies either compared the pharmacokinetics in febrile patients with reported pharmacokinetic values from earlier studies in healthy volunteers (n = 2), or provided no comparison at all and were non-conclusive (n = 4). Conclusion There is a clear knowledge gap regarding the bioavailability of orally administered antibiotics in non-ICU patients during the initial phase of a systemic infection. Well-designed studies on this topic are necessary to elucidate whether patients can benefit from the advantages of an earlier IV-to-oral switch.

Criteria to Achieve Safe Antimicrobial Intravenous-to-Oral Switch in Hospitalised Adult Populations: A Systematic Rapid Review

“…A systematic review [H] investigated early IVOS as being within 48 hours. 29 Three studies (19%) [M] recommended IVOS review to occur after 24 hours. 27, 30, 31…”

“…Studies have since questioned whether an earlier review, such as review within 48 hours of intravenous initiation, is warranted. 29, 40 Van den Broek et al . commented that theoretical reasons for an early switch (even within 24 hours) exist; for example, if patient has an intact gastrointestinal tract and the oral antibiotic option has adequate bioavailability (generally data obtained from studies carried out in healthy and/or critically ill patients).…”

Outcomes for Patients with Urinary Tract Infection After an Initial Intravenous Antibiotics Dose Before Emergency Department Discharge

“…Although it was difficult to distinguish upper UTI and lower UTI in ED most of the time, the results of our study accord with this idea. From the perspective of pharmokinetics, there was a clear gap in bioavailability between intravenous and oral antibiotics for treating bacterial infections, especially in the early phase [ 29 ]. While most oral antibiotics require days to catch up from their initial 50–90% bioavailability, early intravenous antibiotics are recommended for treating patients with sepsis [ 30 , 31 ].…”

Microbial resistance to nanotechnologies: An important but understudied consideration using antimicrobial nanotechnologies in orthopaedic implants

“…Traditional antibiotic treatment via intravenous injection or oral administration often results in premature drug degradation and off-target absorption by non-pathogenic microorganisms [ 138 , 139 ]. The lower-than-expected dosage of antibiotics in the infected area is considered a major cause of antibiotics resistance [ 140 , 141 ]. To circumvent this problem, nanomaterials with a fine-tuned porous or core-shell structure are employed to encapsulate and deliver antibiotics.…”