Is it possible to transition to oral antibiotics from intravenous (IV) antibiotics?

From the Guidelines

It is possible to transition from intravenous (IV) antibiotics to oral antibiotics in many clinical situations, and this practice is commonly used when patients show clinical improvement and can tolerate oral medications. When considering the transition, it's essential to assess the patient's clinical response, evaluating symptoms such as cough, sputum production, dyspnea, fever, and leukocytosis 1. The decision to switch from IV to oral antibiotic therapy should be based on the patient's overall clinical stability, and up to half of all patients may be eligible for this switch on hospital Day 3 1. Some key factors to consider when selecting an oral antibiotic for switch therapy include:

• The patient's ability to tolerate oral medications and have a functioning gastrointestinal tract
• The need to choose an oral antibiotic with a similar spectrum of activity to the IV medication
• The importance of adjusting the dosing appropriately to ensure effective treatment
• The consideration of potential drug-drug interactions and avoiding antacids and certain foods that could interfere with drug absorption 1. Good candidates for oral antibiotics include fluoroquinolones, linezolid, trimethoprim-sulfamethoxazole, metronidazole, clindamycin, and doxycycline, as they have excellent bioavailability 1. However, certain serious infections like endocarditis, meningitis, and severe sepsis generally require completion of the full course with IV antibiotics 1. The benefits of transitioning from IV to oral antibiotics include reduced risk of catheter-related infections, shorter hospital stays, lower healthcare costs, and improved patient comfort and mobility 1.

From the FDA Drug Label

The plasma concentration profile of levofloxacin after IV administration is similar and comparable in extent of exposure (AUC) to that observed for levofloxacin tablets when equal doses (mg/mg) are administered. Therefore, the oral and IV routes of administration can be considered interchangeable [see Figure 2 and Figure 3].

It is possible to transition from intravenous (IV) to oral antibiotics with levofloxacin, as the oral and IV routes of administration can be considered interchangeable 2. This means that patients can be switched from IV levofloxacin to oral levofloxacin without significant changes in the drug's effectiveness. Key points to consider when transitioning from IV to oral antibiotics include:

• Bioavailability: Levofloxacin has a high bioavailability of approximately 99% when taken orally, making it suitable for oral administration.
• Pharmacokinetics: The pharmacokinetic parameters of levofloxacin are similar after oral and IV administration, allowing for interchangeable use.
• Clinical studies: Clinical studies have demonstrated the effectiveness of levofloxacin in treating various infections, including nosocomial pneumonia and community-acquired pneumonia, when administered orally or intravenously 2.

From the Research

Oral Antibiotics Option

• It is possible to transition from intravenous to oral antibiotic treatment, as shown in studies 3, 4, 5, 6.
• The efficacy and safety of early switch from intravenous to oral antibiotics has been investigated in several studies, with results indicating that it is safe to treat mild infections with oral antibiotics only 3.
• For more severe infections, three days of intravenous antibiotics followed by oral antibiotics is typically sufficient 3.
• Oral antibiotics can be used to treat various types of infections, including bloodstream infections 4, bacteraemia and sepsis 6, and community-acquired respiratory tract infections 7.

Benefits of Oral Antibiotics

• Early switch therapy has several benefits, including easier administration and lower expenses 3.
• Oral antibiotics can reduce hospital stay and decrease the risk of intravenous line phlebitis and sepsis 5, 6.
• Oral antibiotics can be used in patients with any infectious disease disorder for which there is effective oral therapy, and is not limited to certain infectious diseases 5.

Suitable Oral Antibiotics

• Antibiotics with high bioavailability, such as chloramphenicol, clindamycin, metronidazole, and fluconazole, are ideal for oral switch therapy 5.
• Other antibiotics, such as beta-lactams and macrolides, may also be used in oral switch programs, although they have lower bioavailability 5.
• Orally administered cephalosporins, such as cefdinir, cefpodoxime, and cefuroxime, have been shown to be effective against various bacterial pathogens 7.