When can a patient be switched from intravenous (IV) cefepime to an oral (PO) antibiotic?

From the Guidelines

A patient can be switched from intravenous (IV) cefepime to an oral (PO) antibiotic when they meet specific clinical criteria, including improvement in symptoms, being afebrile, and having a decreasing white blood cell count, as well as having a functioning gastrointestinal tract with adequate oral intake 1. When considering the switch from IV cefepime to an oral antibiotic, several factors must be taken into account to ensure the transition does not compromise the patient's recovery or increase the risk of treatment failure.

• Clinical improvement is a key indicator, with patients showing signs of recovery from their infection, such as reduced cough and dyspnea, and a fever that is under control, ideally afebrile on two occasions 8 hours apart 1.
• The patient's white blood cell count should be decreasing, indicating that the infection is being effectively managed by the current IV antibiotic regimen.
• A functioning gastrointestinal tract with adequate oral intake is crucial for the absorption of oral antibiotics, ensuring that the patient can tolerate and effectively absorb the medication.
• The choice of oral antibiotic should be based on the spectrum of the IV agent used, considering the need to continue coverage for potential pathogens, especially if the etiologic pathogen is not identified 1.
• Compliance with oral therapy is critical, and thus, agents with minimal side effects and convenient dosing schedules (once or twice daily) should be preferred to enhance the likelihood of the patient completing the full course of therapy 1.
• Patients should be educated on potential drug-drug interactions and how to avoid them, as well as the importance of not taking antacids or certain foods that could interfere with drug absorption. The transition from IV to oral antibiotics, including switching from cefepime, offers several benefits, including reduced risks associated with IV catheters, shorter hospital stays, lower healthcare costs, and improved patient comfort, all while maintaining the efficacy of the antibiotic treatment. However, the decision to switch should always prioritize the patient's clinical status and the specifics of their infection, considering factors such as the severity of the infection, the patient's immune status, and the site of infection.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Switching from IV Cefepime to PO Antibiotic

• The decision to switch from intravenous (IV) cefepime to an oral (PO) antibiotic depends on various factors, including the patient's clinical response, the presence of a suitable oral antibiotic option, and the patient's ability to absorb oral medications 2, 3.
• Cefepime is a parenteral fourth-generation cephalosporin with a broad spectrum of antibacterial activity, but it is not available in an oral formulation 4, 5.
• Switch therapy, or step-down therapy, is a concept where a patient is switched from an IV antibiotic to an oral preparation after a few days, once the condition of the patient has improved and the pathogen and its susceptibility have been determined 2.
• Studies have shown that switch therapy to oral cefixime, a third-generation cephalosporin, can be effective in treating various infections, including community-acquired pneumonia, and can reduce hospital stay and costs 2, 3.
• The criteria for switching to an oral antibiotic include resolution of fever, improvement of symptoms, improvement of laboratory parameters, and presence of normal gastrointestinal tract absorption 3.
• It is essential to note that cefepime is not interchangeable with oral cephalosporins like cefixime, and the decision to switch should be based on the patient's individual response and the susceptibility of the pathogen 4, 5.

Key Considerations

• The patient's clinical response to IV cefepime should be evaluated before considering a switch to an oral antibiotic 3.
• The presence of a suitable oral antibiotic option, such as cefixime, should be considered based on the pathogen's susceptibility and the patient's ability to absorb oral medications 2, 6.
• The decision to switch should be made on a case-by-case basis, taking into account the patient's individual needs and response to treatment 4, 5.