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