Do you transition to oral antibiotics to treat uncomplicated Staphylococcus aureus bacteremia after patients have improved with intravenous antibiotic therapy?

I don't understand the design of these "PO vs IV" abx trials. RCTs, of course, are done to minimize the differences between the experimental and control groups. Hopefully, through randomization, the only significant difference will be the "experiment" or treatment. However, in this and most "PO" studies, several, different po regimens are used. In this study, TMP/SMX 160/800 BID, clinda 600 TID, and linezolid 600 BID were used. I couldn't find the breakdown of how many patients received which po drug. Assume that the IV regimens used have known, similar efficacies (this is a big assumption since IV Vanco was used for some with MSSA bacteremia). In essence, this one trial is at least 3 different RCTs, one for each PO regimen. Actually, the p...

I agree with Dr. @Dr. First Last, further these are tissue drugs more than bloodstream drugs. That’s why they don’t work well in bacteremia.

I agree with Dr. @Dr. First Last's comment on the selection of oral antibiotics. The secondary endpoints cannot be analyzed as only 3-4% of patients screened were enrolled/not powered to assess. As per the Supplementary material, the number of patients who received Cotrimoxazole, Clindamycin, and Linezolid were 58%, 32%, and 8%, respectively. The selection of oral agents such as bactrim/clindamycin may have influenced the results on secondary endpoints. No conclusions can be made for MRSA infections (8% of enrolled participants).

With regard to clinical practice, I found a few notable points.

1. The study included study participants with indwelling devices [prosthetic joint (implanted at least 6 months prior), ICD/pacemaker (implanted at le...

I'm very interested in the PO switch, have done it in only 2 cases in the past year. I think the poll verifies that we all have not quite accepted this approach yet.

With the availability of dalbavancin, I normally do not have to consider this query for long -- I'm generally able to complete the course of treatment by a single IV injection of dalbavancin 1.5 gm instead of using PO options.