From the Guidelines
Discharging a patient with bacteremia on oral antibiotics is not recommended as the initial treatment, and intravenous (IV) antibiotics should be used initially to ensure adequate blood levels and effective treatment of the bloodstream infection. Bacteremia typically requires a comprehensive approach to identify the source and extent of the infection, with elimination and/or debridement of other sites of infection, as recommended by clinical guidelines 1. The use of IV antibiotics such as vancomycin or daptomycin is recommended for at least 2 weeks for uncomplicated bacteremia, and 4-6 weeks for complicated bacteremia, depending on the extent of infection 1. Some key considerations for managing bacteremia include:
- Conducting a clinical assessment to identify the source and extent of the infection
- Elimination and/or debridement of other sites of infection
- Use of echocardiography, with transesophageal echocardiography (TEE) preferred over transthoracic echocardiography (TTE), to evaluate for infective endocarditis
- Evaluation for valve replacement surgery if certain criteria are met, such as large vegetation or severe valvular insufficiency When transitioning to oral therapy, medication selection should be based on culture and sensitivity results, with options like levofloxacin, trimethoprim-sulfamethoxazole, linezolid, or amoxicillin-clavulanate depending on the specific pathogen, as guided by the most recent and highest quality evidence 1. The total duration of antibiotic therapy (IV plus oral) typically ranges from 7-14 days, though this varies based on the infection source and organism. This approach is preferred because bacteremia represents a serious systemic infection where ensuring adequate antibiotic levels in the bloodstream is crucial for effective treatment and preventing complications like endocarditis, metastatic infections, or septic shock.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Discharging Patients with Bacteremia on Oral Antibiotics
- The decision to discharge a patient with bacteremia on oral antibiotics depends on various factors, including the characteristics of the pathogen, the patient, and the drug 2.
- Studies have shown that oral antibiotics can be a safe and effective choice for treating bacterial bloodstream infections, especially for uncomplicated episodes 2, 3.
- A retrospective cohort study found that transitioning to oral antibiotics to complete treatment of Gram-negative bloodstream infections can offer many advantages, including reduced hospital length of stay, treatment costs, and line-related complications 3.
- Another study found that oral β-lactam antibiotics may be a reasonable step-down treatment option for Enterobacterales bacteremia from a suspected urine source, primarily when alternative options are limited by resistance or adverse effects 4.
Considerations for Discharge on Oral Antibiotics
- Patients who are clinically stable, without signs of shock, or have been stabilized after an initial septic presentation, may be appropriate candidates for treatment of bacteremia with oral antimicrobials 2.
- The choice of oral antibiotic should be based on the susceptibility of the pathogen and the patient's clinical condition 2, 4.
- Close monitoring of the patient's condition and adjustment of the antibiotic regimen as needed is crucial to ensure effective treatment and prevent complications 2, 5.
Risks and Benefits of Oral Antibiotics for Bacteremia
- Oral antibiotics offer several potential benefits, including lower cost, fewer side effects, and promotion of antimicrobial stewardship 2.
- However, there are also risks associated with oral antibiotics, such as the potential for treatment failure or recurrent bacteremia 3, 4.
- A study found that the risk of death remains increased for years after bacteremia, and the most common causes of death are cancer and cardiovascular diseases 6.