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Typically, I make the mistake of IV then PO for pyelonephritis. Not usually SSTI. Not sure of the logic that it is reasonable to use IV-->PO for SSTI if you obs them for 24 hours. Not sure I have ever seen an SSTI improve in 24 hours.
Thanks for the comment! This comes up a lot, especially because the current (but dated) IDSA guidelines say to do just that for UTI/pyelo with local resistance (even though there is no evidence an IV dose is beneficial). For SSTI, you are correct that we often may not see improvement in 24 hours. Sometimes it's not even an SSTI. The principle still holds true. If you think the patient really needs IV antibiotics, start them on the IV version of what you think they'll go home on. Some OBS stays last 48 hours, so you should have a good idea if there has been improvement, or at least no more progression.
This was a great discussion. Unfortunately, the written summary of this is really lacking in detail. I am being critical only because there is such good information in the audio, but it is not represented in the summary. The summary is often the area I go to for reference for things while I'm at work. For one, the summary says Bryan goes over 5 errors, but he goes over many more than that. He goes over interactions with coumadin, that is not in the summary at all. That is huge. Hope you guys would be able to update this one. Thx.
Thanks for listening and for your feedback. We will work on updating the show notes. In the meantime, here is the link to my handout for the ACPE talk on which this podcast segment was based: https://pharmertoxguy.files.wordpress.com/2020/10/top-10-antibiotic-mistakes-in-the-ed-handout-hayes-acep-2020.pdf. It has links to all the references.
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