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iv/orale switch

Wanneer switchen naar oraal?

A. Vital signs should be good or improving 
  Systolic blood pressure should be stable without inotropics or fluid resuscitation 
B. Signs and symptoms related to the infection have to be resolved or improved 
  Temperature should be  >36 °C  AND <38.3°C (a) without antipyretics,  
C. The gastrointestinal tract (GIT) has to be intact and functioning 
Absence of the following conditions 
  malabsorption syndrome, short bowel syndrome, severe gastroparesis, ileus, continuous  nasogastric suction   
D. The oral route should not be compromised 
  No vomiting  
  Patient should be cooperative 
E. Absence of contraindicated infections 
  Adequate antimicrobial concentrations are not achievable at the site of infection by oral administration 
Absence of the following infections 
  (severe) sepsis 
  fasciitis necroticans 
  CNS infection 
S. aureus bacteraemia 
  endovascular infection (e.g. endocarditis) 
F. An oral variant (b) of the antibiotic with good (c) bioavailability has to exist 


a Chosen by the experts.

b Oral variant can be another antibiotic with appropriate microbiological profile.

c 60%–90%, in accordance with the literature.


Bron: Akhloufi H, Hulscher M, Melles DC, Prins JM, van der Sijs H, Verbon A. Development of operationalized intravenous to oral antibiotic switch criteria. J Antimicrob Chemother. 2017;72:543-546.