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In patients with soft tissue infection, the practice of using outpatient IV antibiotics is becoming more commonplace. Vancomycin is one of the most frequently selected agents, but is it being used correctly? Is once a day enough? Bryan Hayes says… no. Most people will clear vancomycin before the 24 hour mark and need to be dosed at least twice daily. But this brings up the larger question- is IV vancomycin the best choice in the first place?
Alexander M. - June 7, 2017 9:59 AM
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. - June 7, 2017 10:11 AM
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/.