scholarly journals 4CPS-214 Improving intravenous to oral switch by identifying and tackling barriers perceived by physicians and nurses

2020 ◽  
Author(s):  
S Von Winckelmann ◽  
E Boey ◽  
V Verheyen
Keyword(s):  
Oral Switch

The intravenous to oral switch of taxanes: strategies and current clinical developments

2020 ◽  
Author(s):  
Marit AC Vermunt ◽  
Andries M Bergman ◽  
Eric van der Putten ◽  
Jos H Beijnen
Keyword(s):  
Clinical Trials ◽  
Anticancer Agents ◽  
Hospital Care ◽  
Oral Treatment ◽  
Chemotherapy Treatment ◽  
Intravenous Treatment ◽  
Improve Cost Effectiveness ◽  
Oral Switch ◽  
Tumor Types ◽  
Improve Cost

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. This review summarizes the current clinical developments in oral taxane treatment. Intravenous parent drugs, strategies in the oral switch, individual agents in clinical trials, challenges and further perspectives on treatment with oral taxanes are subsequently discussed.

Case 1

2020 ◽  
pp. 2-8
Author(s):  
Hilary Humphreys
Keyword(s):  
Prophylactic Antibiotics ◽  
Group A Streptococci ◽  
Drug Of Choice ◽  
Group A ◽  
Subcutaneous Tissues ◽  
Oral Switch ◽  
Healthcare Associated ◽  
Panton Valentine Leukocidin ◽  
Initial Drug ◽  
Valentine Leukocidin

Cellulitis is infection of the dermis and subcutaneous tissues unlike erysipelas which is more superficial and necrotizing fasciitis which involves deeper layers. Cellulitis is most commonly caused by Group A streptococci (GAS) and Staphylococcus aureus, including Panton–Valentine leukocidin-producing isolates. However, most cases are diagnosed clinically and the initial drug of choice is flucloxacillin. Five to ten days of treatment is usually adequate including an early intravenous to oral switch but prophylactic antibiotics may be considered for patients with two or more episodes to prevent further recurrence. There is poor evidence for the benefit of using adjuvant therapy, such as corticosteroids and intravenous immunoglobulin, in more severe cases. Healthcare-associated clusters or outbreaks may be associated with carriage of GAS in a staff member who should be treated if positive.

CP-205 Evaluation of outcomes of the implementation of an early oral switch antimicrobial strategy: a before–after study

2017 ◽  
Author(s):  
MJ Cumbraos Sánchez ◽  
FJ Ruiz Laiglesia ◽  
JR Paño Pardo ◽  
D Sánchez Fabra ◽  
J Arribas García ◽  
...  
Keyword(s):  
Oral Switch

Intravenous-to-Oral Switch in Anticancer Chemotherapy: A Focus on Docetaxel and Paclitaxel

2009 ◽  
Vol 87 (1) ◽  
pp. 126-129 ◽  
Author(s):  
S L W Koolen ◽  
J H Beijnen ◽  
J H M Schellens
Keyword(s):  
Anticancer Chemotherapy ◽  
Oral Switch

scholarly journals Comparison of Pharmacokinetics and Safety of Voriconazole Intravenous-to-Oral Switch in Immunocompromised Adolescents and Healthy Adults

2011 ◽  
Vol 55 (12) ◽  
pp. 5780-5789 ◽  
Author(s):  
Timothy A. Driscoll ◽  
Haydar Frangoul ◽  
Eneida R. Nemecek ◽  
Donald K. Murphey ◽  
Lolie C. Yu ◽  
...  
Keyword(s):  
Body Weight ◽  
Steady State ◽  
Oral Treatment ◽  
Area Under The Curve ◽  
Pharmacokinetic Data ◽  
Young Adolescents ◽  
Dosing Regimens ◽  
Oral Switch ◽  
To Receive ◽  
Higher Doses

ABSTRACTThe current voriconazole dosing recommendation in adolescents is based on limited efficacy and pharmacokinetic data. To confirm the appropriateness of dosing adolescents like adults, a pharmacokinetic study was conducted in 26 immunocompromised adolescents aged 12 to <17 years following intravenous (IV) voriconazole to oral switch regimens: 6 mg/kg IV every 12 h (q12h) on day 1 followed by 4 mg/kg IV q12h, then switched to 300 mg orally q12h. Area under the curve over a 12-hour dosing interval (AUC0–12) was calculated using a noncompartmental method and compared to the value for adults receiving the same dosing regimens. On average, the AUC0–12in adolescents after the first loading dose on day 1 and at steady state during IV treatment were 9.14 and 22.4 μg·h/ml, respectively (approximately 34% and 36% lower, respectively, than values for adults). At steady state during oral treatment, adolescents also had lower average exposure than adults (16.7 versus 34.0 μg·h/ml). Larger intersubject variability was observed in adolescents than in adults. There was a slight trend for some young adolescents with low body weight to have lower voriconazole exposure. It is likely that these young adolescents may metabolize voriconazole more similarly to children than to adults. Overall, with the same dosing regimens, voriconazole exposures in the majority of adolescents were comparable to those in adults. The young adolescents with low body weight during the transitioning period from childhood to adolescence (e.g., 12 to 14 years old) may need to receive higher doses to match the adult exposures. Safety of voriconazole in adolescents was consistent with the known safety profile of voriconazole.

scholarly journals Efficacy of Early Oral Switch with β-Lactams for Low-Risk Staphylococcus aureus Bacteremia

2020 ◽  
Vol 64 (7) ◽  
Author(s):  
Olivia Bupha-Intr ◽  
Tim Blackmore ◽  
Max Bloomfield
Keyword(s):  
Staphylococcus Aureus ◽  
Deep Infection ◽  
Primary Treatment ◽  
Low Risk ◽  
Prosthetic Material ◽  
Beta Lactam ◽  
Related Complication ◽  
Content Type ◽  
Staphylococcus Aureus Bacteremia ◽  
Oral Switch

ABSTRACT The aim of this study was to assess the safety of early oral switch (EOS) prior to 14 days for low-risk Staphylococcus aureus bacteremia (LR-SAB), which is the primary treatment strategy used at our institution. The usual recommended therapy is 14 days of intravenous (i.v.) antibiotics. All patients with SAB at our hospital were identified between 1 January 2014 and 31 December 2018. Those meeting low-risk criteria (health care-associated, no evidence of deep infection or demonstrated involvement of prosthetic material, and no further positive blood cultures after 72 h) were included in the study. The primary outcome was occurrence of a SAB-related complication within 90 days. There were 469 SAB episodes during the study period, 100 (21%) of whom met inclusion criteria. EOS was performed in 84 patients. In this group, line infection was the source in 79%, methicillin-susceptible S. aureus caused 95% of SABs and 74% of patients received i.v. flucloxacillin. The median durations of i.v. and oral antibiotics in the EOS group were 5 days (interquartile range [IQR], 4 to 6) and 10 days (IQR, 9 to 14), respectively. A total of 71% of patients received flucloxacillin as their EOS agent. Overall, 86% of oral step-down therapy was with beta-lactams. One patient (1%) undergoing EOS had SAB relapse within 90 days. No deaths attributable to SAB occurred within 90 days. In this low-MRSA-prevalence LR-SAB cohort, EOS was associated with a low incidence of SAB-related complications. This was achieved with oral beta-lactam therapy in most patients. Larger prospective studies are needed to confirm these findings.

Early Oral Switch to Linezolid for Low-risk Patients With Staphylococcus aureus Bloodstream Infections: A Propensity-matched Cohort Study

2018 ◽  
Vol 69 (3) ◽  
pp. 381-387 ◽  
Author(s):  
Rein Willekens ◽  
Mireia Puig-Asensio ◽  
Isabel Ruiz-Camps ◽  
Maria N Larrosa ◽  
Juan J González-López ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Cohort Study ◽  
Propensity Score ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Length Of Hospital Stay ◽  
Low Risk ◽  
Significant Difference ◽  
Risk Patients ◽  
Oral Switch

Abstract Background Oral switch to linezolid is a promising alternative to standard parenteral therapy (SPT) in Staphylococcus aureus bacteremia (SAB). Methods We conducted a prospective cohort study of all adult cases of SAB between 2013 and 2017 in a Spanish university hospital. We compared the efficacy, safety, and length of hospital stay of patients receiving SPT and those where SPT was switched to oral linezolid between days 3 and 9 of treatment until completion. We excluded complicated SAB and osteoarticular infections. A k-nearest neighbor algorithm was used for propensity score matching with a 2:1 ratio. Results After propensity score matching, we included 45 patients from the linezolid group and 90 patients from the SPT group. Leading SAB sources were catheter related (49.6%), unknown origin (20.0%), and skin and soft tissue (17.0%). We observed no difference in 90-day relapse between the linezolid group and the SPT group (2.2% vs 4.4% respectively; P = .87). No statistically significant difference was observed in 30-day all-cause mortality between the linezolid group and the SPT group (2.2% vs 13.3%; P = .08). The median length of hospital stay after onset was 8 days in the linezolid group and 19 days in the SPT group (P < .01). No drug-related events leading to discontinuation were noted in the linezolid group. Conclusions Treatment of SAB in selected low-risk patients with an oral switch to linezolid between days 3 and 9 of treatment until completion yielded similar clinical outcomes as SPT, allowing earlier discharge from the hospital.

scholarly journals A Retrospective Analysis of Practice Patterns in the Treatment of Methicillin-ResistantStaphylococcus aureusSkin and Soft Tissue Infections at Three Canadian Tertiary Care Centres

2003 ◽  
Vol 14 (6) ◽  
pp. 315-321 ◽  
Author(s):  
John M Conly ◽  
H Grant Stiver ◽  
Karl A Weiss ◽  
Debbie L Becker ◽  
Andrew J Rosner ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Oral Treatment ◽  
Tertiary Care ◽  
Treatment Patterns ◽  
Soft Tissue Infections ◽  
Alternative Analysis ◽  
Eligibility Criteria ◽  
Switch Therapy ◽  
Oral Switch ◽  
The Mean

BACKGROUND: Methicillin-resistantStaphylococcus aureus(MRSA) infections are increasingly being encountered and pose an increasing burden to the health care system in Canada.OBJECTIVE: To elucidate and characterize the factors influencing the current MRSA treatment patterns in patients with skin and soft tissue infections (SSTIs) before linezolid became available on the Canadian market.METHODS: A retrospective study collected demographic, treatment and resource use data on patients hospitalized at one of three geographically distinct tertiary care facilities, where MRSA SSTI treatment was initiated with intravenous (IV) vancomycin. Analysis of opportunities for IV-to-oral switch therapy was based on eligibility criteria.RESULTS: Of 89 patients identified over a 43-month period, the mean (±SD) durations of anti-infective treatment and hospitalization were 22.4±21 days and 28.9±20.8 days, respectively. An infected surgical wound was most common, representing 62.9% of infections. The mean duration of vancomycin treatment was 19.5 days and the mean number of 1 g doses received was 29.0±32.9. The majority of patients (55.1%) initiated vancomycin therapy a mean of 5.4±8.9 days after confirmation of MRSA. Of the 70% of patients meeting criteria for IV-to-oral switch therapy, only 10% received oral treatment. The most common reason cited for not switching was lack of an effective oral alternative. Analysis of switch therapy criteria found that IV treatment continued for a mean of 13 days despite the appropriateness of the oral route.CONCLUSIONS: Considerable variation exists in treatment patterns for MRSA infections. Improvements in the initiation of therapy and the use of IV-to-oral switch therapy may improve care and reduce the duration of hospitalization for MRSA SSTIs.

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