Could a regimen of oral and IV antibiotics be a more effective strategy for treating serious infections acquired by persons who inject drugs? According to researchers at Washington University School of Medicine, this novel intervention not only may work better, but will also allow individuals the opportunity to return home faster to finish their antibiotic treatment. New research published this past April 2020 in Clinical Infectious Diseases describes their discovery.
Lead author Laura Marks, MD, PhD, clinical fellow in infectious diseases and affiliated with Division of Infectious Diseases, Washington University, in St. Louis School of Medicine and colleagues examined three study cohorts of IV drug users with serious infections who 1) received a partial course of IV antibiotics followed by oral antibiotics on discharge , 2) received a partial course of IV antibiotics and no oral antibiotics, or 3) received a full course of IV antibiotics prior to discharge. The authors highlighted statistics reflecting that injection drug users have a 16.3 times higher incidence developing invasive Staphylococcus aureus infections and experience higher readmission rates and mortality for endovascular infections.
According to Dr. Marks, “Most people don’t want to stay in the hospital for weeks at a time to get IV antibiotics when they could be treated at home.” She added, “But until recently, infectious disease doctors had limited evidence on effective treatment options for patients who could not complete long courses of IV antibiotics. No one wants to offer an ineffective treatment for what could be a life-threatening infection, and so we required everyone to stay. Now we recognize that when someone does not want to stay in the hospital, we can work with the patient to find another way to provide antibiotics.”
The team conducted a retrospective cohort study of patients aged 18 years and older who were injection drug users, were admitted to a tertiary referral center, and received an infectious disease evaluation for invasive fungal or bacterial infection between January 2016 and July 2019. Of the 293 individuals in the study, those who left the hospital without completing their IV regimen and who did not receive oral antibiotics were more than twice as likely to be readmitted for any reason within 90 days of discharge compared with those who completed the full course of IV therapy prior to discharge (n = 43, 31.5%) and those who completed a partial IV regimen and received oral antibiotics on discharge (n = 27, 32.5%).
The authors concluded that because little evidence exists regarding best practices for caring for patients with invasive fungal and bacterial infections, their single-center study supports the use of oral antibiotics for individuals who cannot or do not complete a prolonged course of IV antibiotics prior to discharge.
“It doesn’t matter why patients have an infection,” said Dr. Marks. “We want to make sure that we provide antibiotics to patients in a setting they prefer. If they are not comfortable staying in the hospital throughout their treatment, we will work to get them back home as soon as it is it is safe, and they can finish their treatment on an oral alternative.”
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