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Am J Infect Control 2022 May 27. Epub 2022 May 27.

Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.

Background: This review aimed to summarize the available evidence on the effectiveness and safety of antimicrobial stewardship interventions to improve the practice of IV-to-PO antimicrobial switch therapy in hospitalized adults.

Methods: Following the PRISMA guidelines, we searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE/PubMed, and Scopus from inception to September 1, 2020, for original articles investigating any interventions aimed to improve the practice of IV-to-PO antimicrobial switch therapy in hospitalized adults with infectious diseases. We included randomized controlled trials (RCTs) and quasi-experimental studies. Read More

BMJ Open 2022 04 8;12(4):e053010. Epub 2022 Apr 8.

Pharmacy department, Universitaire Ziekenhuizen Leuven, Leuven, Belgium.

Objectives: Early switch from intravenous to oral therapy of bioequivalent drugs has major advantages but remains challenging. At our hospital, a basic clinical rule was designed to automatically alert the physician to review potential intravenous to oral switch (IVOS). A rather low acceptance rate was observed. Read More

Ugeskr Laeger 2022 03;184(12)

Hjertecentret, Københavns Universitetshospital - Rigshospitalet.

Infective endocarditis (IE) is one of the most severe infectious diseases with an in-hospital mortality of 20-25%. Several studies have shown, that the incidence of IE is increasing, and that patients now are older with a higher burden of comorbidities than previously. The diagnostic work-up is mainly based upon the presence of bacteraemia and echocardiography. Read More

Yakugaku Zasshi 2022 ;142(2):189-193

Department of Infectious Diseases, St. Marianna University School of Medicine Hospital.

We report a rare case of suppurative thrombophlebitis of the posterior neck caused by Streptococcus constellatus. A 69-year-old female patient was admitted to the hospital with neck pain and fever, which had persisted for 16 days prior to hospitalization. On day 1 (day of admission), blood cultures (later identifying S. Read More

Int J Antimicrob Agents 2022 Mar 31;59(3):106541. Epub 2022 Jan 31.

Infectious Diseases Clinical Pharmacist, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153, USA.

The Infectious Diseases Society of America (IDSA) recommends numerous antibiotics for the treatment of urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL)-producing bacteria. The purpose of this study was to evaluate clinical outcomes of oral step-down antibiotics compared with continued intravenous therapy in UTIs without bacteraemia. This multicentre, retrospective, cohort study was conducted in hospitalised patients with ESBL-producing UTIs between July 2016 and March 2020. Read More

Antibiotics (Basel) 2021 Dec 4;10(12). Epub 2021 Dec 4.

Summa Health, Akron, OH 44304, USA.

Lefamulin was the first systemic pleuromutilin antibiotic approved for intravenous and oral use in adults with community-acquired bacterial pneumonia based on two phase 3 trials (Lefamulin Evaluation Against Pneumonia [LEAP]-1 and LEAP-2). This pooled analysis evaluated lefamulin efficacy and safety in adults with community-acquired bacterial pneumonia caused by atypical pathogens (, , and ). In LEAP-1, participants received intravenous lefamulin 150 mg every 12 h for 5-7 days or moxifloxacin 400 mg every 24 h for 7 days, with optional intravenous-to-oral switch. Read More

J Glob Antimicrob Resist 2022 03 13;28:53-58. Epub 2021 Dec 13.

Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Queensland, Australia; School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia.

Objectives: Little is known about the benefits of timely switch from intravenous (IV) to oral antibiotic therapy in children. We evaluated the appropriateness of IV-to-oral switch of antibiotic therapy in remote and regional areas of Australia following the implementation of a multifaceted package of interventions.

Methods: The intervention package, including clinician guidelines, medication review stickers, patient information leaflets and educational resources, was implemented in seven facilities in Queensland, Australia. Read More

Front Neurol 2021 16;12:748413. Epub 2021 Nov 16.

Department of Neurosurgery, Hamburg University Medical Center, Hamburg, Germany.

Several guidelines recommend oral administration of nimodipine as vasospasm prophylaxis after aneurysmal subarachnoid hemorrhage (SAH). However, in clinical practice, the drug is administered orally and intravenously (i.v. Read More

Jpn J Infect Dis 2022 Mar 31;75(2):205-208. Epub 2021 Aug 31.

Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Japan.

Transitioning from intravenous to oral antibiotic therapy for Escherichia coli bacteremia could reduce the length of hospital stay and drug costs without compromising efficacy. Despite the expansion of extended-spectrum β-lactamase (ESBL)-producing E. coli, limited data are available regarding the effectiveness of switching to oral antibiotic therapy in patients with bacteremia caused by this organism. Read More

JAC Antimicrob Resist 2021 Mar 3;3(1):dlab010. Epub 2021 Feb 3.

Graphical Abstract. Read More

Saudi Pharm J 2021 Apr 23;29(4):324-336. Epub 2021 Mar 23.

Medical Microbiology and Parasitology Department, Faculty of Medicine, King Abdulaziz University, Jeddah 21422-5107, Saudi Arabia.

Overutilization of intravenous (IV) medications can result in drug shortages, which is one of the major health care crisis, in addition to increasing costs, length of hospital stays (LOS) and the associated complications. We hypothesized that IV therapy was overused at our hospital where oral (PO) was applicable, and that the implementation of IV-PO protocol could result in a cost-effective practice. Hence, we aimed at assessing impact and outcomes of implementing such a protocol. Read More

BMC Pulm Med 2021 May 8;21(1):154. Epub 2021 May 8.

Olive View-UCLA Medical Center, Los Angeles, CA, USA.

Background: Lefamulin, a first-in-class pleuromutilin antibiotic approved for intravenous and oral use in adults with community-acquired bacterial pneumonia (CABP), was noninferior to moxifloxacin in the Lefamulin Evaluation Against Pneumonia (LEAP) 1 intravenous-to-oral switch study and the LEAP 2 oral-only study. Using pooled LEAP 1/2 data, we examined lefamulin efficacy/safety overall and within subgroups of patients presenting with comorbidities typical in CABP management.

Methods: In LEAP 1, adults with CABP were randomized to receive intravenous lefamulin (150 mg every 12 h) for 5‒7 days or moxifloxacin (400 mg every 24 h) for 7 days, with optional intravenous-to-oral switch if predefined improvement criteria were met. Read More

BMC Musculoskelet Disord 2021 Mar 30;22(1):315. Epub 2021 Mar 30.

Department of Infectious and Tropical Diseases, CHU Nîmes, University of Montpellier, Nîmes, France.

Background: The optimal duration of intravenous antibiotic therapy in Staphylococcus aureus prosthetic bone and joint infection has not been established. The objective of this study was to compare the effect of early and late intravenous-to-oral antibiotic switch on treatment failure.

Patients And Methods: We retrospectively analyzed all adult cases of S. Read More

BMJ Open Qual 2021 03;10(1)

Medication Safety, Clinical Excellence Commission, Sydney, New South Wales, Australia.

Children in hospital are frequently prescribed intravenous antibiotics for longer than needed. Programmes to optimise timely intravenous-to-oral antibiotic switch may limit excessive in-hospital antibiotic use, minimise complications of intravenous therapy and allow children to go home faster. Here, we describe a quality improvement approach to implement a guideline, with team-based education, audit and feedback, for timely, safe switch from intravenous-to-oral antibiotics in hospitalised children. Read More

Clin Infect Dis 2021 09;73(5):895-898

Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.

In this retrospective cohort study, selected patients with disseminated Staphylococcus aureus bacteremia, but without endovascular infection on echocardiography and 18F-FDG-PET/CT, were free of relapse after IV-oral switch. Mortality was low and similar to patients who received prolonged intravenous treatment. IV-oral switch was associated with a shorter length of hospital stay. Read More

Diagn Microbiol Infect Dis 2021 May 6;100(1):115305. Epub 2021 Jan 6.

Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield, UK. Electronic address:

This study aims to identify factors associated with duration of intravenous (IV) and follow-on oral antibiotic therapy for cellulitis in patients treated through outpatient parenteral antimicrobial therapy (OPAT). A retrospective review of episodes of cellulitis treated over a year (January 2018-January 2019) at a large teaching hospital in Sheffield, UK. Overall, 292 OPAT episodes of cellulitis were reviewed. Read More

Br J Clin Pharmacol 2021 08 23;87(8):3354-3358. Epub 2021 Jan 23.

Department of Pharmacy, Austin Health, Melbourne, Victoria, Australia.

Timely intravenous (IV) to oral antimicrobial switch (IV-oral-switch) is a key antimicrobial stewardship (AMS) strategy. We aimed to explore concordance with IV-oral-switch guidelines in the context of a long-standing, tightly regulated AMS program. Data was retrospectively collected for 107 adult general medical and surgical patients in an Australian hospital. Read More

Curr Opin Infect Dis 2021 04;34(2):109-117

Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS.

Purpose Of Review: To summarize the available results of primary analyses from high-quality randomized studies of either recently approved or possible future agents for the treatment of acute bacterial skin and skin structure infections (ABSSSI).

Recent Findings: In the last 2 decades, several novel agents have been approved for the treatment of ABSSSI, that are also active against methicillin-resistant Staphylococcus aureus (MRSA). In addition to already available agents, further molecules are in clinical development that could become available for treating ABSSSI in the forthcoming future. Read More

J Clin Pharm Ther 2021 Jun 4;46(3):780-785. Epub 2021 Jan 4.

Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1104, Japan.

What Is Known And Objective: While bioavailability of oral voriconazole is known to be >90%, several reports have observed much lower oral bioavailability. The aim of the present study was to assess the oral bioavailability of voriconazole in clinical use by evaluating the change in serum voriconazole concentration in patients who received intravenous-to-oral switch therapy with the same dose of voriconazole.

Methods: A single-centre, retrospective cohort study was conducted at the 614-bed Gifu University Hospital in Japan. Read More

Future Oncol 2021 Apr 24;17(11):1379-1399. Epub 2020 Dec 24.

Department of Pharmacy & Pharmacology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands.

The taxanes paclitaxel, docetaxel and cabazitaxel are important anticancer agents that are widely used as intravenous treatment for several solid tumor types. Switching from intravenous to oral treatment can be more convenient for patients, improve cost-effectiveness and reduce the demands of chemotherapy treatment on hospital care. However, oral treatment with taxanes is challenging because of pharmaceutical and pharmacological factors that lead to low oral bioavailability. Read More

Ugeskr Laeger 2020 11;182(48)

During the latest decades, the efficacy and safety of an early switch from intravenous to oral antibiotics has been the topic of several investigations. In this review, we summarise the results of studies, which have shown that it is safe to treat mild infections with oral antibiotics only. For more severe infections, three days of intravenous antibiotics followed by oral antibiotics is typically sufficient. Read More

Int J Clin Pharm 2021 Jun 29;43(3):681-688. Epub 2020 Oct 29.

Department of Internal Medicine, Clinical Pharmacology, Kantonsspital Aarau, 5000, Aarau, Switzerland.

Background Paracetamol is a widely used analgesic and antipyretic drug in hospitals. The development and implementation of an electronic tool with algorithm-based alerts (e-agent) in a clinical information system could reduce the risk of overdose. Objective In this study, the performance of such an e-agent developed to detect paracetamol overdosing was analyzed. Read More

Infect Dis (Lond) 2021 02 24;53(2):102-110. Epub 2020 Oct 24.

Radboud University Medical Center, Nijmegen, The Netherlands.

Background: Knowledge on bacterial co-infections in COVID-19 is crucial to use antibiotics appropriately. Therefore, we aimed to determine the incidence of bacterial co-infections, antibiotic use and application of antimicrobial stewardship principles in hospitalized patients with COVID-19.

Methods: We performed a retrospective observational study in four hospitals (1 university, 2 non-university teaching, 1 non-teaching hospital) in the Netherlands from March to May 2020 including consecutive patients with PCR-confirmed COVID-19. Read More

Int J Antimicrob Agents 2020 Dec 9;56(6):106189. Epub 2020 Oct 9.

School of Pharmacy, Faculty of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa.

Introduction: Pharmacists in low-middle-income countries (LMIC) are few and lack antibiotic stewardship (AS) training. The ability was assessed of non-specialised pharmacists to implement stewardship interventions and improve adherence to the South African community-acquired pneumonia (CAP) guideline in public and private hospitals.

Methods: This was a multicentre, prospective cohort study of adult CAP patients hospitalised between July 2017 and July 2018. Read More

BMJ Open 2020 08 20;10(8):e038957. Epub 2020 Aug 20.

Infectious Diseases, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.

Introduction: Community-acquired pneumonia (CAP) continues to be a major health problem worldwide and is one of the main reasons for prescribing antibiotics. However, the causative agent is often not identified, resulting in antibiotic overtreatment, which is a key driver of antimicrobial resistance and adverse events. We aim to test the hypothesis that comprehensive molecular testing, compared with routine microbiological testing, would be effective in reducing antibiotic use in patients with CAP. Read More

Trials 2020 May 27;21(1):431. Epub 2020 May 27.

Centre for Cancer Research and Cell Biology, Queen's University Belfast, Lisburn Road, Belfast, BT9 7AE, UK.

Background: Neutropenic sepsis remains a common treatment complication for patients receiving systemic anti-cancer treatment. The UK National Institute for Health and Care Excellence have not recommended switching from empirical intravenous antibiotics to oral antibiotics within 48 h for patients assessed as low risk for septic complications because of uncertainty about whether this would achieve comparable outcomes to using intravenous antibiotics for longer. The UK National Institute for Health Research funded the EASI-SWITCH trial to tackle this uncertainty. Read More

J Infect Chemother 2020 Jul 10;26(7):706-714. Epub 2020 Apr 10.

Advanced Informatics and Analytics, Astellas Pharma Inc., 2-5-1 Nihonbashi Honcho, Chuo-ku, Tokyo, 103-8411, Japan. Electronic address:

The Japanese Respiratory Society 2017 guidelines strongly recommend switching from intravenous (IV) to oral antibiotics in patients with community-acquired pneumonia (CAP), following improvement in clinical symptoms and laboratory findings. Here, we retrospectively investigated the real-world, nationwide treatment and switching patterns for hospitalized patients with CAP in Japan using administrative data from 372 Japanese Diagnosis Procedure Combination hospitals from April 2010 to December 2018. Hospitalizations for CAP (patient age ≥20 years) with an A-DROP classification for CAP severity and IV antibiotics initiated on the admission date were included. Read More

Travel Med Infect Dis 2020 Jul - Aug;36:101605. Epub 2020 Feb 24.

Pharmacy Services Division, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.

Background: The emergence of antimicrobial resistance of many bacteria is a significant drawback of antimicrobial use. A key measure to assess antimicrobial use is point prevalence study.

Methods: This was a point prevalence study of all hospitalized patients at Johns Hopkins Aramco Healthcare, a 350-bed hospital, and was conducted at two-points from January 2017 to January 2019. Read More

BMC Infect Dis 2020 Feb 3;20(1):102. Epub 2020 Feb 3.

Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.

Background: Minimising antimicrobial overuse is needed to limit antimicrobial resistance. There is little evidence on how often microbiological testing informs antimicrobial de-escalation (e.g. Read More

Swiss Med Wkly 2019 Oct 27;149:w20135. Epub 2019 Oct 27.

Division of Internal Medicine, University Hospital Basel, Switzerland / Department of Clinical Research, University of Basel, Switzerland.

Aims Of The Study: Inappropriate use of antimicrobials is associated with the emergence of antimicrobial resistance and adverse events. Antimicrobial stewardship programmes may both optimise treatment of infections and reduce antimicrobial resistance but are implemented in only a minority of Swiss hospitals. In addition, data on prescribing patterns and quality are scarce. Read More