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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 Mar;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

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 Jan 15. Epub 2021 Jan 15.

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 Apr;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 Jan 4. 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

Ugeskr Laeger 2020 Nov;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

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

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

Ir Med J 2019 09 12;112(8):987. Epub 2019 Sep 12.

Discipline of Bacteriology, School of Medicine, National University of Ireland, Galway

Aims To explore doctors’ perceptions of the motivators and barriers to complying with intravenous to oral switch antibiotic guidelines in a Model 4 Irish hospital. Methods A cross-sectional study was carried out amongst doctors attending hospital-wide educational sessions in November 2018 via a validated paper-based survey post ethical approval. Data were independently analysed using SPSS. Read More

Int J Environ Res Public Health 2019 09 23;16(19). Epub 2019 Sep 23.

Members of the Italian Paediatric Collaborative Osteomyelitis Study Group: Luisa Abbagnato (Como); Samantha Bosis (Milano); Grazia Bossi (Pavia); Fabio Cardinale (Bari); Elio Castagnola (Genova); Salvatore Cazzato (Ancona); Liviana Da Dalt (Padova); Sofia D’Elios (Pisa); Icilio Dodi (Parma): Daniele Donà (Padova); Susanna Esposito (Perugia); Susanna Falorni (Grosseto); Silvia Fasoli (Mantova); Enrico Felici (Alessandria); Romina Gallizzi (Messina); Silvia Garazzino (Torino); Maria Rita Govoni (Ferrara); Francesca Landi (Genova); Marcello Lanari (Bologna); Giuseppe Losurdo (Genova); Andrea Lo Vecchio (Napoli); Paola Marchisio (Milano); Flora Marino (Rovigo); Alberto Martelli (Garbagnate Milanese); Pasqua Massagli (Bari); Antonella Meini (Brescia); Alessandra Meneghel (Vicenza); Chiara Minotti (Padova); Gregorio Paolo Milani (Milano); Alma Nunzia Olivieri (Napoli); Luca Pierantoni (Bologna); Diego Peroni (Pisa); Roberta Ponti (Udine); Simone Rugolotto (Rovigo); Paola Serraino (Alessandria); Simone Sferrazza Papa (Chieti); Monica Sprocati (Ferrara); Camilla Totaro (Bologna); Gianluca Vergine (Rimini); Alberto Verrotti (L’Aquila).

: The European Society of Pediatric Infectious Diseases (ESPID) guidelines for acute hematogenous osteomyelitis (AHOM) have been published recently. In uncomplicated cases, an early (2-4 days) switch to oral empirical therapy, preferentially with flucloxacillin, is recommended in low methicillin-resistant settings. We conducted a survey with the aim of evaluating the behaviors of Italian pediatricians at this regard. Read More

Rev Esp Quimioter 2019 Sep;32 Suppl 2:42-46

Jose L del Pozo, Infectious Diseases Division and Clinical Microbiology. Clínica Universidad de Navarra, Spain.

Sepsis is the major cause of mortality from any infectious disease worldwide. The goals of antimicrobial stewardship are to achieve optimum clinical outcomes and to ensure cost effectiveness and minimum unintended consequences, including toxic effects, selection of pathogenic organisms, and resistance. The combination of inadequate diagnostic criteria for sepsis with the extraordinary time pressure to provide broad-spectrum antimicrobial therapy is troubling from a stewardship perspective. Read More

J Antimicrob Chemother 2019 11;74(11):3344-3351

Department of Internal Medicine, Division of Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.

Background: Staphylococcus aureus bacteraemia (SAB) is a serious and often fatal infectious disease. The quality of management of SAB is modifiable and can thus affect the outcome. Quality indicators (QIs) can be used to measure the quality of care of the various aspects of SAB management in hospitals, enabling professionals to identify targets for improvement and stimulating them to take action. Read More

Int J Antimicrob Agents 2020 Jan 27;55(1):105769. Epub 2019 Jul 27.

Department of Clinical Pharmacy, Meander Medical Center, Amersfoort, The Netherlands. Electronic address:

Objectives: To assess the effectiveness of a combined intervention on the timing and rate of switching from intravenous (IV) to oral antibiotic therapy.

Materials And Methods: The study used a historically-controlled prospective intervention design. Interventions consisted of educating physicians, handing out pocket-sized cards and providing switch advice in the electronic patient record (EPR). Read More

BMC Infect Dis 2019 Jul 22;19(1):650. Epub 2019 Jul 22.

School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.

Background: This study aimed to evaluate the oral switch (OS) stewardship intervention in the intensive care unit (ICU).

Methods: This was a retrospective study with a convenience sample in two Brazilian ICUs from different hospitals in patients with sepsis receiving antibiotic therapy. The stewardship intervention included OS in patients diagnosed with sepsis when clinical stability was achieved. Read More

Core Evid 2019 5;14:31-40. Epub 2019 Jul 5.

Department of Health Sciences, University of Genoa, Genoa, Italy.

Introduction: Tedizolid phosphate is an oxazolidinone approved for the treatment of acute bacterial skin and skin-structure infections (ABSSSIs) and active against methicillin-resistant .

Aims: The objective of this article was to review the evidence for the efficacy and safety of tedizolid phosphate for the treatment of ABSSSI.

Evidence Review: Approval of tedizolid phosphate for the treatment of ABSSSI was based on the results of two phase III randomized controlled trials, ESTABLISH-1 (NCT01170221) and ESTABLISH-2 (NCT01421511), comparing 6-day once-daily tedizolid vs 10-day twice-daily linezolid. Read More

BMJ Open 2019 07 9;9(7):e026688. Epub 2019 Jul 9.

Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.

Introduction: High morbidity and mortality rates of proven bacterial infection are the main reason for substantial use of intravenous antibiotics in neonates during the first week of life. In older children, intravenous-to-oral switch after 48 hours of intravenous therapy has been shown to have many advantages and is nowadays commonly practised. We, therefore, aim to evaluate the effectiveness, safety and cost-effectiveness of an early intravenous-to-oral switch in neonates with a probable bacterial infection. Read More

Clin Microbiol Infect 2020 Mar 23;26(3):299-306. Epub 2019 May 23.

Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA.

Background: The role of oral antimicrobial agents in the management of bloodstream infections (BSI) is currently evolving.

Objectives: This narrative review summarizes and appraises clinical studies that examined transition from intravenous to oral antimicrobials or compared effectiveness of various oral agents for definitive therapy of uncomplicated and complicated BSI in adults.

Sources: Relevant English-language studies from MEDLINE (since inception) and presented abstracts at international scientific meetings (since 2017). Read More

Expert Opin Drug Saf 2019 08 13;18(8):635-650. Epub 2019 Jun 13.

b Department of Health Sciences, University of Genoa , Genoa , Italy.

Introduction: Acute bacterial skin and skin-structure infections (ABSSSI) may develop in both in-patients and out-patients, possibly with a severe clinical presentation. Since most phase 3 randomized clinical trials have shown non-inferiority in efficacy across different agents, considerations regarding their different safety profiles inevitably play a crucial role in the everyday choice about which of them should be employed for the treatment of ABSSSI.

Areas Covered: In this review, the authors discuss the safety profile of different treatment options for ABSSSI. Read More

Int J Mol Sci 2019 May 15;20(10). Epub 2019 May 15.

Department of Pharmacy, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.

Single nucleotide polymorphisms in drug-metabolizing genes may affect tacrolimus pharmacokinetics. Here, we investigated the influence of genotypes of , , and on the concentration/dose (C/D) ratio of tacrolimus and episodes of acute graft-versus-host disease (GVHD) in Japanese recipients of allogeneic hematopoietic stem cell transplantation (HSCT). Thirty-six patients receiving the first HSCT using tacrolimus-based GVHD prophylaxis were enrolled with written informed consent. Read More

Braz J Infect Dis 2019 Mar - Apr;23(2):86-94. Epub 2019 May 9.

Pfizer Inc, Groton, CT, USA.

Background: Early antibiotic switch and early discharge protocols have not been widely studied in Latin America. Our objective was to describe real-world treatment patterns, resource use, and estimate opportunities for early switch from intravenous to oral antibiotics and early discharge for patients hospitalized with methicillin-resistant Staphylococcus aureus complicated skin and soft-tissue infections.

Materials/methods: This retrospective medical chart review recruited 72 physicians from Brazil to collect data from patients hospitalized with documented methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections between May 2013 and May 2015, and discharged alive by June 2015. Read More

Ther Adv Infect Dis 2019 Jan-Dec;6:2049936118823655. Epub 2019 Feb 4.

Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK.

Purpose: The objective of this prospective, observational study was to describe the treatment, severity assessment and healthcare resources required for management of patients with acute bacterial skin and skin structure infections who were unsuitable for beta-lactam antibiotic treatments.

Methods: Patients were enrolled across five secondary care National Health Service hospitals. Eligible patients had a diagnosis of acute bacterial skin and skin structure infection and were considered unsuitable for beta-lactam antibiotics (e. Read More

PLoS One 2018 29;13(11):e0207413. Epub 2018 Nov 29.

Division of Infectious Diseases, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka, Japan.

The most common complication in cancer patients is catheter-related bloodstream infection (CRBSI), of which Staphylococcus aureus is a common pathogen. Although S. aureus CRBSI patients are recommended for prolonged intravenous therapy, this is often not feasible. Read More

Ann Pharm Fr 2019 Jan 6;77(1):38-45. Epub 2018 Oct 6.

Service pharmaceutique, hospices Civils de Lyon, hôpital de la Croix-Rousse, groupement hospitalier Nord, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France. Electronic address:

Introduction: Potassium is used to treat or prevent hypokalemia and exhibits all the characteristics of an intravenous to oral therapy conversion program. Despite this, the intravenous route for potassium replacement seems frequently unjustified.

Objectives: To determine the impact of a conversion program on the use of intravenous and oral galenic forms in a university tertiary care hospital. Read More