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.