Febrile 126: IV vs PO
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Dec 1, 2025 Hannah Chute, a fourth-year medical student, presents complex clinical cases focusing on diabetic foot infections and endocarditis. Dr. Paloma Reta-Impey, an infectious diseases fellow, discusses the latest guidelines on managing these conditions, emphasizing IV versus oral therapies. Dr. Brad Spellberg, chief medical officer and antibiotic stewardship expert, highlights evidence supporting oral treatments when patients are stable. The conversation delves into patient-centered decision-making, the benefits of oral therapies, and the nuances of managing infections in vulnerable populations.
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Treat Bone Differently Than Soft Tissue
- Diabetic foot osteomyelitis needs longer therapy than soft-tissue infections when bone is involved.
- Guidelines allow either IV or oral therapy and suggest ~3 weeks if infected bone is retained after debridement.
Switch To Oral When Clinically Stable
- Transition to oral therapy once the patient is hemodynamically stable and can absorb oral meds.
- Ensure oral agents achieve bone concentrations and clinical data support their use before discharging on PO.
Unhoused Patient With MRSA Endocarditis
- A 37-year-old unhoused man with MRSA tricuspid endocarditis and septic arthritis cleared blood cultures by day five.
- Team discussed that IV therapy is typical, but oral transition is possible with stability and social support.