If you have ever said to a patient – and meant it – that they needed to stay for “antibiotics in the IV” and you were not giving CefeVancoSyn, read further and take your educational beating. There is a paucity of data on IV being equivalent to PO, but at least there is some – and its reviewed in this post. However, there is no significant data on an IV antibiotic being better, faster, stronger than its PO counterpart – for just about anything clinically significant, except for very antibiotic-specific instances (example: IV vs PO vanco, for SSTI or CDiff).
In a comparison of PO Augmentin vs IV Augmentin transitioned to PO Augmentin vs IV Cephalosporin transitioned to PO Cephalosporins for lower respiratory tract infections, there were no significant differences between clinical outcome or mortality. Patients in the PO only group, shockingly, had a reduced hospital stay.
In a Cochrane Review, oral treatment has been show to be an acceptable alternative to IV antibiotic treatment in febrile neutropenic patients without pneumonia or skin / soft tissue infection, organ failure, or central line infection, who are also hemodynamically stable. Mortality and treatment failure were similar. I am not saying to discharge them on oral antibiotics from the ED – despite MASCC saying you can – but you may transition them home sooner and stop the snowball effect “the need for IV antibiotics” can have on a patient.
There are a handful of studies which show PO antibiotics equivalent to IV antibiotics for initial management of pediatric pyelonephritis – with comparable renal scarring, adverse reactions, and treatment failure as well.
Next time you start IV Levaquin for “a loading dose” on a patient that can tolerate oral antibiotics, think about this post, the added cost to the patient, and nursing time spent setting up IV treatment. Stop the snowball effect in the ED, the patient can continue PO on the floor, and likely leave the hospital sooner, without compromising safety.
Do NOT even consider “an IV dose in the ED and go home.”
Oral versus intravenous antibiotic treatment for febrile neutropenia in cancer patients. PMID: 15495074
Oral versus intravenous antibiotics for community acquired lower respiratory tract infection in a general hospital: open, randomised controlled trial. PMID: 7787537
Are oral antibiotics equivalent to intravenous antibiotics for the initial management of pyelonephritis in children? PMID: 21358894