What clinical criteria do you use to decide whether to continue intravenous gentamicin or fluoroquinolone for the full duration of treatment or to step down to oral therapy in hospitalized patients with tularemia?  

There are no prospective, controlled trials for the treatment of tularemia. I am comfortable in treating mild-moderate infections with a PO quinolone. In severe infections (meningitis, endocarditis, extensive pneumonia, etc.), I would definitely start parenterally and step down to an oral regimen wh...