Oral beta-lactams, including cephalosporins, can be a suitable treatment option for respiratory infections like COPD exacerbations or uncomplicated cellulitis.
The use of oral beta-lactams in osteomyelitis and endocarditis requires careful patient selection and adherence to guidelines.
Deep dives
Cephalosporin Pearls for Oral Therapy
When it comes to first-generation cephalosporins, cephalexin is commonly used, but cephedroxil is an oral cephalosporin with great bioavailability that is often overlooked. It can be dosed twice daily and may be worth considering more often. Additionally, for automatic IV-to-PO protocols, some hospitals are converting cephradine to cephalexin for urinary tract infections if the organism is susceptible. This excludes bacteremia. For respiratory infections, such as COPD exacerbations or uncomplicated cellulitis, oral beta-lactams, including cephalosporins, can be a suitable treatment option.
Cephalosporins in Osteomyelitis and Endocarditis
The landmark OVIVA trial and poet study have shed light on the efficacy of oral antibiotics for the treatment of osteomyelitis and endocarditis, respectively. While oral beta-lactams were not the main focus, these studies demonstrate that oral therapy can be non-inferior to IV therapy for selected patients. Factors to consider are adequate source control, clinical response to initial IV therapy, compliance, and pathogen susceptibility. The use of oral beta-lactams in osteomyelitis and endocarditis requires careful patient selection and adherence to guidelines.
Future Research Opportunities
Future research opportunities regarding oral beta-lactams include developing pharmacokinetic models for a wider range of patients and doses, with a focus on optimizing concentrations above the minimum inhibitory concentration. Investigating non-traditional dosing regimens could enhance efficacy while ensuring patient safety and tolerability. Additionally, correlating susceptibility results of oral cephalosporins with their corresponding parenteral agents would improve dosing decisions when interpreting microbiology reports. These research avenues will further inform the use of oral beta-lactams in various clinical scenarios.
Dr. Jill Cowper (@jillcowper), and Dr. Jesse Sutton, join host Dr. Zahra Kassamali Escobar (@zkePharmD) to discuss the data behind use of oral beta-lactams as step-down therapy for bacteremia and other serious infections.
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Arensman K, Shields M, Beganovic M, et al. Fluoroquinolone versus beta-lactam oral step-down therapy for uncomplicated streptococcal bloodstream infections. Antimicrob Agents Chemother 2020;64(11):e01515-20.
Seaton RA, Ritchie ND, Robb F, et al. From 'OPAT' to 'COpAT': implications of the OVIVA study for ambulatory management of bone and joint infection. J Antimicrob Chemother. 2019 Aug 1;74(8):2119-2121.
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