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intravenous antibiotic therapy

Adverse effects: - 25% of patients who receive at least 2 weaks of IV antibiotics develop eosinophilia [6] - only vancomycin associated with excess risk of DRESS [6] Management: - blood cultures should be drawn prior to initiation of intravenous antibiotic therapy - all patients on IV antibiotics with intact GI system whose clinical status is improving should be considered for switch to oral therapy [1,2] - continued inpatient monitoring of stable patients after transition from IV to oral antibiotics does not improve outcomes [1] - outpatient IV antibiotics may be appropriate for selected patients [1] - if used for <= 14 days, midline catheters have fewer major complications than PICC [8]

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antibiotic therapy

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.
  2. Masterton RG Antibiotic de-escalation. Crit Care Clin. 2011 Jan;27(1):149-62 PMID: 21144991
  3. Cunha BA. Oral antibiotic therapy of serious systemic infections. Med Clin North Am. 2006 Nov;90(6):1197-222. Review. PMID: 17116444
  4. Chapman AL. Outpatient parenteral antimicrobial therapy. BMJ. 2013 Mar 26;346:f1585. Review. PMID: 23532865
  5. Seaton RA, Barr DA. Outpatient parenteral antibiotic therapy: principles and practice. Eur J Intern Med. 2013 Oct;24(7):617-23. Review. PMID: 23602223
  6. Blumenthal KG et al. Peripheral blood eosinophilia and hypersensitivity reactions among patients receiving outpatient parenteral antibiotics. J Allergy Clin Immunol 2015 Nov; 136:1288. PMID: 25981739
  7. Cyriac JM, James E. Switch over from intravenous to oral therapy: A concise overview. J Pharmacol Pharmacother. 2014 Apr;5(2):83-7. Review. PMID: 24799810 Free PMC Article
  8. Paje D, Walzl E, Heath M et al. Midline vs peripherally inserted central catheter for outpatient parenteral antimicrobial therapy. JAMA Intern Med 2024 Nov 11; [e-pub]. PMID: 39527077 PMCID: PMC11555572 Free PMC article https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2825765