Pharmacology Pearls - Cellulitis and Outpatient Vancomycin

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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
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Xander Merboo -

I'm wondering why we're talking about starting with IV formulations of subsequent PO regimens that have equivalent bioavailability. Seems like there has been a big push lately to NOT start IV abx if the regimen is able to be given PO due to lack of difference in effect

Bryan H. -

Great point. Apologies if that was not clear in the podcast. In practice, the decision to start IV antibiotics and 'observe' the patient overnight for improvement is routinely done. Most patients can receive oral antibiotics right from the start without the need for IV. In fact, even one-time dose of IV antibiotics portends higher likelihood of c. diff and antibiotic-associated diarrhea (https://www.ncbi.nlm.nih.gov/pubmed/25149599). One helpful article that might guide who should get IV (vs. PO) outlines risk factors for failing outpatient therapy. Here is a quick summary: https://em.umaryland.edu/educational_pearls/2429/.

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