One Small Step (Down) for Antibiotics, One Giant Leap for Outpatient Therapy: The Role of Oral Antibiotics in Serious Bacterial Infections

• Published in: Current infectious disease reports 2023-12, Vol.25 (12), p.293-304
• Main Authors: Ortwine, Jessica K., Wei, Wenjing, Mang, Norman S., Hall, Brenton C., Ding, Helen
• Format: Article
• Language: English
• Subjects: Antibiotics; Antimicrobial Development and Drug Resistance (KC Claeys and J Smith; Bacterial diseases; Bacterial infections; Bioavailability; Clinical trials; Endocarditis; Infections; Infectious Diseases; Medical instruments; Medicine; Medicine & Public Health; Section Editors; Topical Collection on Antimicrobial Development and Drug Resistance
• ISSN: 1523-3847; 1534-3146
• DOI: 10.1007/s11908-023-00823-7

Purpose of Review Stepping down to oral antibiotic therapy after a period of IV lead-in would eliminate most of the untoward effects of long-term intravenous therapy, including lengthy hospital admissions, copays for ambulatory infusions, catheter-related adverse events, and missed work/school. Recent Findings Two randomized, controlled trials, POET and OVIVA, contribute significant support for oral stepdown regimens in endocarditis and osteomyelitis, disease states that are commonly caused by gram-positive organisms. In addition, a number of retrospective reviews comparing early oral switch to continued IV therapy for bacteremia due to Streptococcus and Enterobacterales have shown no significant differences in morality, re-infection, or re-admission. Optimal oral antibiotic selection has been reviewed in a number of studies for gram-negative bacteremia, but similar data is lacking for gram-positive infections. Summary Stepdown to oral antibiotic therapy is a safe, effective, and cost-saving method of treating a range of bacterial infections, especially with highly bioavailable antibiotics. Less bioavailable antibiotics (i.e., β-lactams) may also be effective, but data supporting optimal agent selection and dosing regimens is needed.