How to convert a patient from IV to oral therapy?
Practical approaches for conversion of a patient from IV to oral therapy Establishment of an IV to oral switch over program at a hospital is the stepping stone toward the successful conversion of a patient from IV to oral therapy.
What is the difference between IV and oral route of administration?
INTRODUCTION. Safest and convenient way of medication administration is achieved by oral route. If the given oral medication achieves tissue and blood concentration to the same extent as that of the intravenous (IV) medication, then there is little therapeutic difference between IV and oral medications.
What are the drug classes involved in IV to oral conversion?
INTRODUCTION. Less commonly, doxycycline, and trimethoprim/sulphamethoxazole are also involved in switch over. In the case of antifungals, fluconazole and itraconazole are the two major drugs involved in switch over from IV to oral. [ 11] Various drug classes involved in IV to oral conversion, in the ascending order of preference,...
Is IV infusion therapy the best treatment for C diff?
While there are several oral antibiotics available, IV infusion therapy may be the best option available for patients who are unable to take oral medication or for whom oral medication has proven ineffective. Currently there are a few different infusion medications available to treat C. diff infections:
Why are oral antibiotics preferred over IV?
Using oral rather than parenteral antibiotics Major advantages of oral over the intravenous route are the absence of cannula-related infections or thrombophlebitis, a lower drug cost, and a reduction in hidden costs such as the need for a health professional and equipment to administer intravenous antibiotics.
Why is oral vancomycin used for C. difficile?
Oral vancomycin is a glycopeptide antibiotic that is used for the treatment of Clostridium difficile diarrhea and staphylococcal enterocolitis. Vancomycin is a bactericidal antibiotic (it kills bacteria) that exerts its effects by preventing bacteria from forming cell walls, which they need to survive.
Which is better IV or oral antibiotics?
Among physicians and patients alike, it is generally accepted that IV antibiotics are better than oral. They are stronger. They will work faster. They will save the day when oral antibiotics have failed.
Which is more effective oral or IV?
Bioavailability of IV medications is always higher than that of their oral counterpart, so that the patient may get relief from symptoms earlier if they receive a complete IV course of therapy, is a concept that is popular among the physicians.
Why can't you use IV vancomycin for C diff?
Higher dosing (250 mg PO [or per nasogastric tube] QID) may be used in situations such as ileus. Excretion of the drug into bile and exudation from the inflamed colon results in bactericidal levels in feces. Intravenous vancomycin is ineffective and should not be used for C difficile.
Why is oral vancomycin given for C diff and not IV?
bacteria. These antibiotics — such as oral vancomycin or oral fidaxomicin — are suited to target the C. diff bacteria more directly, in order to prevent its spread and eliminate it from your system. Vancomycin is perhaps the most common treatment for C.
When should IV antibiotics be switched to oral?
The majority of patients presenting with a severe infection who require IV therapy initially can be switched to oral therapy after 24-48 hours provided that they are improving clinically and are able to tolerate an oral formulation.
Why some drug doses are different when given IV rather than orally?
Some drugs that are particularly well absorbed by the gastrointestinal mucosa may have bioavailability comparable to that of an IV dose – for example the antibiotic ciprofloxacin. Most drugs do not have this availability by the oral route so the dose given orally is usually higher than that given parenterally.
Do IV antibiotics cause less diarrhea?
Taking oral or intravenous antibiotic medication may cause diarrhea in 20% to 40% of people. Often this type of diarrhea is mild and goes away when you finish taking the antibiotic medication. However, some people get a more serious type of diarrhea from a germ called Clostridium difficile or C. difficile.
Why is the oral route of administration safer?
Oral route Many drugs can be administered orally as liquids, capsules, tablets, or chewable tablets. Because the oral route is the most convenient and usually the safest and least expensive, it is the one most often used. However, it has limitations because of the way a drug typically moves through the digestive tract.
What is the best treatment for C diff?
Vancomycin is perhaps the most common treatment for C. diff. infection and is currently the recommended first-line medication for severe cases. It is an antibiotic medication particularly suited for treating infections in the gastrointestinal system. When used for C diff, Vancomycin must be given by mouth and not by IV.
What is C diff infusion?
Infection. Clostridium difficile, more commonly referred to as C. diff, is a type of bacteria that can cause serious infections and illness in the gastrointestinal system. Most frequently, the development of C. diff occurs after prolonged antibiotic treatment — especially among the elderly ...
What antibiotics are used to treat C. diff?
diff. bacteria. These antibiotics — such as oral vancomycin or oral fidaxomicin — are suited to target the C. diff bacteria more directly, in order to prevent its spread and eliminate it from your system.
How does infusion therapy work?
How Infusion Therapy Works for C. Diff. Infection. Antibiotic treatments work by destroying bacteria inside your body. While the intended result is always to target and eliminate the bacteria that caused the infection, a common secondary effect is the destruction of some healthy bacteria as well. Since healthy bacteria helps fight ...
What is an infusion associate?
At Infusion Associates, we provide medically-prescribed infusion therapy in a welcoming and friendly environment. Our team of healthcare professionals is fully committed to making the experience as comfortable as possible for you or your patients. We always inform patients of any potential side effects and answer all their questions before starting treatment. In addition, we have a Registered Pharmacist on-site to make the process as seamless as possible.
What are the symptoms of C diff?
In severe cases, however, these symptoms are more intense and can also include: Fever. Abdominal swelling. Increased heart rate. Bloody stools. Kidney failure. C. diff. can be a serious condition to overcome, but treatments like infusion therapy can help.
Can you take antibiotics with IV infusion?
While there are several oral antibiotics available, IV infusion therapy may be the best option available for patients who are unable to take oral medication or for whom oral medication has proven ineffective.
Why is it important to switch over from IV to oral?
Early switch over from IV to oral therapy has the following major advantages: Reduced risk of cannula-related infections: For the administration of IV medications, one is required to insert a cannula, which remains in place for some days and eventually can result in secondary infections caused by bacteria and fungi.
Which drugs are used to switch over from IV to oral?
Less commonly, doxycycline, and trimethoprim/sulphamethoxazole are also involved in switch over. In the case of antifungals, fluconazole and itraconazole are the two major drugs involved in switch over from IV to oral.[11] .
What are the advantages of IV?
Early switch over from IV to oral therapy has the following major advantages: 1 Reduced risk of cannula-related infections: For the administration of IV medications, one is required to insert a cannula, which remains in place for some days and eventually can result in secondary infections caused by bacteria and fungi. This may ultimately lead to the need for additional antibiotics and subsequently financial burden to the patient[1] 2 Risk of thrombophlebitis: No risk of thrombophlebitis in case of oral administration[1,3,11] 3 Less expensive than IV therapy: Most of the oral medications available at the market are less expensive as the parenteral medications must be sterile and isotonic, consequently leading to cost savings by the patient[1,15,16] 4 Reduction in the hidden costs: Hidden costs mainly refer to cost of diluents, equipments for administration, needles, syringes, and nursing time. Needles, syringes, diluents, and other equipments are the unavoidable requisites for the parenteral administration. Above all, an experienced professional must be there to administer the injection. As a result, it may cause a financial burden for the patient and take away valuable nursing time for patient-care[1,15,16] 5 Earlier discharge: Injections are usually administered in a hospital setting as it requires an experienced professional to administer the medication, especially IV infusions. Hence the patient stay at the hospital is prolonged. Early switch over to oral medications can help to overcome this barrier and may result in early discharge of the patient.[1]
What is switch therapy?
Switch therapy: It describes the conversion of an IV medication to a PO equivalent; within the same class and has the same level of potency, but of a different compound. For example, switch over from inj. ceftriaxone 1 g BD (bis in die) to tab. cefixime 200 mg BD,[17] switch over from inj. pantoprazole 40 mg BD to tab. rabeprazole 20 mg BD
What is the best route of administration of a medication?
The ideal route of administration of any medication is the one that achieves serum concentrations sufficient to produce the desired effect without producing any untoward effects .[1] Safest and convenient way of medication administration is achieved by oral route. If the given oral medication achieves tissue and blood concentration to the same extent as that of the intravenous (IV) medication, then there is little therapeutic difference between IV and oral medications.[2] The available oral formulations in the market are easier to administer, safe and achieve desired therapeutic concentrations, thus making the per oral (PO) route an ideal choice.[1,3]
What are the drugs that are used in IV to PO conversion?
Most of the studies related to IV to PO conversions have been restricted to certain antibiotic and certain medical condition like respiratory tract infections.[12,13] Only a few studies have been done to assess physician's knowledge, beliefs and acceptance of the switch over from IV to oral therapy.[2] Antibiotics, gastrointestinal agents (mainly proton pump inhibitors and histamine-2 antagonists), and antifungals are major medication classes that can be utilized in IV to oral switch over.[11] In many of the advanced hospitals in developed countries, flouroquinolones are the predominant drug class which is commonly involved in switch over program.[12,14] The drugs such as metronidazole, azithromycin, and linezolid are also involved in IV to PO conversion program. Less commonly, doxycycline, and trimethoprim/sulphamethoxazole are also involved in switch over. In the case of antifungals, fluconazole and itraconazole are the two major drugs involved in switch over from IV to oral.[11] Various drug classes involved in IV to oral conversion, in the ascending order of preference, are Diuretics < Corticosteroids < Analgesics < Antivirals < Cardiovascular agents < Antifungals < GI agents < Antibacterials.[11]
How many types of IV to PO conversions are there?
There are mainly three types of IV to PO conversions.[1]
Who is ultimately responsible for the timely and continued administration of our medications?
With oral therapies, WE are ultimately responsible for the timely and continued administration of our medications.
Can you give IV chemo?
It is not true that real old school chemotherapy can only be given IV.
Is oral versus IV chemo moot?
So in summary, while the decision about oral versus IV may be moot for many of us, as we may only have one logical therapeutic choice that is only is available in one form, when we do have a choice, we should make our decision on the particulars of the drugs and our willingness to embrace the responsibility of being our own chemo nurse if we chose the pill.
Is CML a leading cause of resistance?
And if we look at the track record of the patients with our cousin leukemia, CML, where skipping doses is a leading cause of developing resistance, we cancer patients are not always doing a super job of caring for ourselves.
Does insurance cover infusions?
Insurance coverage varies widely from state to state and country to country, but often ironically drugs administered by a medical doctor in an office or infusion center or hospital have much lower co-pays and out of pocket costs for us patients.
Can you be at home with CLL?
For those of us receiving oral treatments for our CLL, we would most likely be at home if a severe reaction occurred and not under the watchful eye of an oncology nurse at the infusion center with an already established IV access to administer potentially lifesaving drugs.
Can you give a drug by IV?
Take Away Points: Many drugs can be given either orally or by IV. A drug’s potency or toxicity cannot be judged by knowing its route of administration. Both IV and oral therapies carry their own set of advantages and risks. Skipping doses of oral medications is a leading cause of developing resistant disease.
How to prevent CDI?
CDI can be prevented by using antibiotics appropriately and implementing infection control recommendations to prevent transmission.
How long does it take for a CDI to resolve?
Although in about 20% of patients, CDI will resolve within two to three days of discontinuing the antibiotic to which the patient was previously exposed, CDI should usually be treated with an appropriate course (about 10 days) of treatment, including oral vancomycin or fidaxomicin. After treatment, repeat C. diff testing is not recommended if the patient’s symptoms have resolved, as patients often remain colonized.
What is a PCR test for C diff?
Molecular tests: FDA-approved PCR assays, which test for the gene encoding toxin B, are same-day tests that are highly sensitive and specific for the presence of a toxin-producing C. diff organism. Molecular assays can be positive for C. diff in individuals who are asymptomatic.
How long does it take for C diff to be undetectable?
C. diff toxin is very unstable. The toxin degrades at room temperature and might be undetectable within two hours after collection of a stool specimen. False-negative results occur when specimens are not promptly tested or kept refrigerated until testing can be done.
What is C diff?
C. diff is a spore-forming, Gram-positive anaerobic bacillus that produces two exotoxins: toxin A and toxin B. It is a common. cause of antibiotic-associated diarrhea (AAD). It accounts for 15 to 25% of all episodes of AAD.
Why is ribotype 027 declining?
This decline in ribotype 027 might be partly driven by a decreased use of fluoroquinolone in U.S. hospitals. Continued efforts to improve adherence to recommended infection prevention measures and implement diagnostic and antibiotic stewardship in both inpatient and outpatient settings will further reduce CDI.
Is colonization more common than CDI?
Colonization is more common than CDI. The patient exhibits NO clinical symptoms (asymptomatic) but does test positive for the C. diff organism or its toxin.With infection, the patient exhibits clinical symptoms and tests positive for the C. diff organism or its toxin. Top of Page.
What is CDI in adults?
Summarized below are recommendations intended to improve the diagnosis and management of Clostridium difficile infection (CDI) in adults and children. CDI is defined by the presence of symptoms (usually diarrhea) and either a stool test positive for C. difficile toxins or detection of toxigenic C. difficile, or colonoscopic or histopathologic findings revealing pseudomembranous colitis. In addition to diagnosis and management, recommended methods of infection control and environmental management of the pathogen are presented. The panel followed a process used in the development of other Infectious Diseases Society of America (IDSA) guidelines, which included a systematic weighting of the strength of recommendation and quality of evidence using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system (Figure 1). A detailed description of the methods, background, and evidence summaries that support each of the recommendations can be found in the full text of the guidelines. The extent to which these guidelines can be implemented is impacted by the size of the institution and the resources, both financial and laboratory, available in the particular clinical setting.
How is CDI surveillance done?
In the United States, CDI surveillance in healthcare facilities is conducted via the CDC’s NHSN Multidrug-Resistant Organism and C. difficile Infection Module LabID Event Reporting [16]. To allow for risk-adjusted reporting of healthcare-associated infections (HAIs), CDC calculates the standardized infection ratio (SIR) by dividing the number of observed events by the number of predicted events. The number of predicted events is calculated using LabID probabilities estimated from models constructed from NHSN data during a baseline time period, which represents a standard population [16]. These have been recently updated using a 2015 baseline period with specific models developed for each of 4 facility types: acute care hospitals, long-term acute care hospitals, critical access hospitals (rural hospitals with ≤25 acute care inpatient beds), and inpatient rehabilitation facilities [17]. Use of more sensitive tests (eg, NAATs) for C. difficile have been demonstrated to result in substantial increases in reported CDI incidence rates compared with those derived from toxin detection by enzyme immunoassay [18, 19]. Consistent with this, the impact of test type on facilities’ reported rates is an independent predictor in each of the aforementioned NHSN risk adjustment models except that for critical access hospitals [17]. The prevalence of CO cases not associated with the facility (ie, defined in NHSN as present-on-admission with no discharge from the same facility within the previous 4 weeks) is also associated with HO-CDI [20, 21]. This likely reflects colonization pressure in the admitted patient population, and is an independent predictor in each of the NHSN risk adjustment models except for inpatient rehabilitation facilities [17].
What is the highest rate of C difficile in children?
difficile in children is the presence of asymptomatic colonization with either toxigenic or nontoxigenic strains among many infants and young children, with the highest rates (which can exceed 40% ) in infants <12 months of age [134–141].
What is HO-CDI surveillance?
At a minimum, conduct surveillance for HO-CDI in all inpatient healthcare facilities to detect elevated rates or outbreaks of CDI within the facility (weak recommendation, low quality of evidence).
What is the most appropriate denominator for HO-CDI rates?
Because the risk of CDI increases with the length of stay, the most appropriate denominator for HO-CDI rates is the number of patient-days. If a facility notes an increase in the incidence of CDI from the baseline rate, or if the incidence is higher than in comparable institutions or above national and/or facility reduction goals, surveillance data should be stratified by hospital location or clinical service to identify particular patient populations where infection prevention measures may be targeted. In addition, measures should be considered for tracking severe outcomes, such as colectomy, intensive care unit (ICU) admission, or death, attributable to CDI.
What is the first step in developing a rational clinical research agenda?
The initial step in developing a rational clinical research agenda is the identification of gaps in information. The process of guideline development, as practiced by SHEA and the IDSA, serves as a natural means by which such gaps are identified. Clinical questions identified by the IDSA/SHEA Expert Panel and by members of the IDSA Research Committee that could inform a C. difficile research agenda are listed below.
What is the Ovid platform used for?
In addition, the strategies focused on articles published in English or in any language with available English abstracts. The Ovid platform was used to search 5 electronic evidence databases: Medline, Embase, Cochrane Central Registry of Controlled Trials, Health Technology Assessment, and the Database of Abstracts of Reviews of Effects.
How many doses of metronidazole are needed for C difficile colitis?
To be included, patients had to fulfill the following criteria: 1) at least six doses (equivalent to two days of therapy) of intravenous metronidazole were administered, 2) no other potential cause for colitis was found, and 3) the diagnosis of C. difficile colitis was firmly established.
Is metronidazole effective for C. difficile?
Intravenous metronidazole may be effective therapy in patients with C. difficile colitis. A randomized, prospective study appears warranted.