in the New England Journal of Medicine showed six weeks of oral antibiotics to be noninferior to 6 weeks of IV antibiotics for treatment of osteoarticular infections . 6 Proving that the cardiologists aren ’ t the only ones that can have slick acronyms for studies , the POET ( Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis ) examined whether oral antibiotics could be used to complete therapy for left sided endocarditis following at least 10 days of IV antibiotics . 7 After six months , those randomized to oral antibiotics had noninferior outcomes to those who were randomized to complete therapy parenterally .
Why the handwringing on IV vs PO ? Two reasons . First , ask most any patient treated with outpatient IV antibiotics , and they can speak eloquently to how disruptive it is to daily life . Taking a pill antibiotic is so much more convenient than taking IV antibiotics one to multiple times a day . Second , and perhaps more importantly , studies have consistently shown that about a quarter of patients discharged on IV antibiotics will have complications either from toxicities of the antibiotics themselves or device complications ( e . g . line infection , deep vein thrombosis ). 8
That ’ s a staggeringly high number when you think about it : one in four ! Next time you are tempted to discharge a patient on IV antibiotics “ just in case ,” remember the haunting one in four statistic . If there is any easier and safer way to treat a condition , despite how anxiety-provoking it is to the doctor , we should choose it . After all , when considering IV vs PO , the bug can die just the same . Dr . Klausing is an infectious disease specialist with Baptist Health Medical Group .
References
1 . Eisinger RW , Dieffenbach CW , Fauci AS . HIV Viral Load and Transmissibility of HIV Infection : Undetectable Equals Untransmittable . JAMA . 2019 Feb 5 ; 321 ( 5 ): 451-452 . doi : 10.1001 / jama . 2018.21167 . PMID : 30629090 .
2 . Spellberg B , Rice LB . Duration of Antibiotic Therapy : Shorter Is Better .
EMERGING TRENDS IN INFECTIOUS DISEASE
Ann Intern Med . 2019 Aug 6 ; 171 ( 3 ): 210-211 . doi : 10.7326 / M19-1509 . Epub 2019 Jul 9 . PMID : 31284302 ; PMCID : PMC6736742 .
3 . Table shared with permission . The reader is also encouraged to visit Dr . Spellberg ’ s website for full references and more stewardship resources at https :// www . bradspellberg . com / shorter-is-better
4 . Miller MB , Atrzadeh F , Burnham CA , Cavalieri S , Dunn J , Jones S , Mathews C , McNult P , Meduri J , Newhouse C , Newton D , Oberholzer M , Osiecki J , Pedersen D , Sweeney N , Whitfield N , Campos J ; ASM Clinical and Public Health Microbiology Committee and the ASM Corporate Council . Clinical Utility of Advanced Microbiology Testing Tools . J Clin Microbiol . 2019 Aug 26 ; 57 ( 9 ): e00495-19 . doi : 10.1128 / JCM . 00495-19 . PMID : 31217268 ; PMCID : PMC6711927 .
5 . Ramanan P , Bryson AL , Binnicker MJ , Pritt BS , Patel R . Syndromic Panel-Based Testing in Clinical Microbiology . Clin Microbiol Rev . 2017 Nov 15 ; 31 ( 1 ): e00024-17 . doi : 10.1128 / CMR . 00024-17 . PMID : 29142077 ; PM- CID : PMC5740973 .
6 . Li HK , Rombach I , Zambellas R , Walker AS , McNally MA , Atkins BL , Lipsky BA , Hughes HC , Bose D , Kümin M , Scarborough C , Matthews PC , Brent AJ , Lomas J , Gundle R , Rogers M , Taylor A , Angus B , Byren I , Berendt AR , Warren S , Fitzgerald FE , Mack DJF , Hopkins S , Folb J , Reynolds HE , Moore E , Marshall J , Jenkins N , Moran CE , Woodhouse AF , Stafford S , Seaton RA , Vallance C , Hemsley CJ , Bisnauthsing K , Sandoe JAT , Aggarwal I , Ellis SC , Bunn DJ , Sutherland RK , Barlow G , Cooper C , Geue C , McMeekin N , Briggs AH , Sendi P , Khatamzas E , Wangrangsimakul T , Wong THN , Barrett LK , Alvand A , Old CF , Bostock J , Paul J , Cooke G , Thwaites GE , Bejon P , Scarborough M ; OVIVA Trial Collaborators . Oral versus Intravenous Antibiotics for Bone and Joint Infection . N Engl J Med . 2019 Jan 31 ; 380 ( 5 ): 425-436 . doi : 10.1056 / NEJMoa1710926 . PMID : 30699315 ; PMCID : PMC6522347 .
7 . Iversen K , Ihlemann N , Gill SU , Madsen T , Elming H , Jensen KT , Bruun NE , Høfsten DE , Fursted K , Christensen JJ , Schultz M , Klein CF , Fosbøll EL , Rosenvinge F , Schønheyder HC , Køber L , Torp-Pedersen C , Helweg-Larsen J , Tønder N , Moser C , Bundgaard H . Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis . N Engl J Med . 2019 Jan 31 ; 380 ( 5 ): 415-424 . doi : 10.1056 / NEJMoa1808312 . Epub 2018 Aug 28 . PMID : 30152252 .
8 . Norris AH , Shrestha NK , Allison GM , Keller SC , Bhavan KP , Zurlo JJ , Hersh AL , Gorski LA , Bosso JA , Rathore MH , Arrieta A , Petrak RM , Shah A , Brown RB , Knight SL , Umscheid CA . 2018 Infectious Diseases Society of America Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapy . Clin Infect Dis . 2019 Jan 1 ; 68 ( 1 ): e1-e35 . doi : 10.1093 / cid / ciy745 . PMID : 30423035 .
Racial Inequality in Medicine
Seminar 1 - JANUARY 14TH AT 6PM Speaker - Dr . Karen Krigger To register visit - www . glms . org / Register
Other sessions in this series : FEBRUARY 11th & MARCH 11th
JANUARY 2021 11