Early oral antibiotic switch a good alternative to prolonged IV treatment in gram-negative bacteraemia

In the treatment of uncomplicated gram-negative bacteraemia, switching to oral antibiotics within 4 days appears to be effective, with the all-cause mortality risk comparable to that of continued intravenous (IV) antibiotic treatment, according to a study.

To assess the effectiveness of an early switch to oral antibiotics in the treatment of uncomplicated gram-negative bacteraemia, researchers applied the target trial emulation framework and used an observational cohort involving 914 patients (median age 74.5 years, 56.0 percent men) across four hospitals in Copenhagen, Denmark.

The included patients had a blood culture positive for growth of gram-negative bacteria, clinical stability within 4 days of initial blood culture, an available susceptibility report on day 4, and were initiated on appropriate empirical IV antibiotic treatment within 24 hours of blood culture.

Of the patients, 47.4 percent switched early to oral antibiotic treatment and 52.6 percent received prolonged IV treatment. During the 90-day follow-up, more patients in the prolonged-treatment group than in the early-switch group died (14.3 percent vs 6.9 percent).

Intention-to-treat analysis showed that the rates of 90-day all-cause mortality, the primary study endpoint, were 9.1 percent (95 percent confidence interval [CI], 6.7–11.6) in the early-switch group and 11.7 percent (95 percent CI, 9.6–13.8) in the prolonged-treatment group (risk difference [RD], −2.5 percent, 95 percent CI, −5.7 to 0.7; risk ratio [RR], 0.78, 95 percent CI, 0.60–1.10).

In the per-protocol analysis, the RD was −0.1 percent (95 percent CI, −3.4 to 3.1) and the RR was 0.99 (95 percent CI, 0.70–1.40).

The findings suggest that transition to oral antibiotics within 4 days of initial blood culture may be an effective alternative to prolonged IV treatment.