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Analogue of ampicillin, is a semisynthetic antibiotic with essentially the all patients who present agar (Biokar) were prepared and sterilized according to the manufacturers instructions. Another drug and may not reflect the rates.

Illness usually resulting from the figure Open consumption rate by country for 2015 in DDDs per 1,000 inhabitants per day. Has a known history of allergy to antibiotics.

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aureus BSI should be made in conjunction with an infectious diseases specialist; 14 days is currently regarded as a minimum.

Published data regarding oral treatment of coagulase-negative Staphylococcus (CoNS) BSI are limited. Most CoNS bacteremia and up to 80% Staphylococcus epidermidis bacteremia represent blood culture contamination, though true infection from CoNS is not uncommon, particularly in patients with indwelling catheters.

60 An exception is the CoNS species Staphylococcus lugdunensis, which is more virulent, and bacteremia with this organism usually warrants antibiotics. Oral antimicrobial therapy is currently not a standard treatment practice for CoNS BSI that is felt to represent true infection; however, linezolid has been successfully used in case series. aureus, infective endocarditis must be ruled out when treating enterococcus BSI; a scoring system has been proposed to assist in deciding if such patients require echocardiography.

62 Intravenous ampicillin is a preferred, highly effective agent for enterococci treatment when the organism is susceptible. 44 However, oral ampicillin has poor bioavailability (50%), and data for its use in BSI are lacking.

For susceptible strains, amoxicillin has comparable efficacy for enterococci and enhanced bioavailability (85%); high dose oral amoxicillin could be considered, but there is minimal clinical trial data to support this approach.

Fluoroquinolones exhibit only modest activity against enterococci and would be an inferior choice for BSI. 63 Although often sensitive to oral tetracyclines, data on their use in enterococcal BSI are insufficient. Nitrofurantoin can be used for susceptible enterococcal urinary tract infection; however, it does not achieve high blood concentrations and should not be used for BSI. There is significant data comparing oral linezolid with intravenous

daptomycin

for vancomycin-resistant enterococci (VRE) BSI. In a systematic review including 10 trials using 30-day all-cause mortality as the primary outcome, patients treated with daptomycin demonstrated higher odds of death (OR 1.61, 95% CI 1.082.40) compared with those treated with linezolid. 64 However, more recent data suggested that higher daptomycin doses than those used in these earlier trials resulted in improved VRE BSI outcomes.

65 A subsequent study reported that VRE BSI treatment with linezolid is associated with significantly higher treatment failure and mortality compared with daptomycin therapy. 66 Further research is needed, but should the side-effect profile of linezolid be tolerable, it remains an effective option for oral treatment of enterococcal BSIs.

Evidence Regarding Anaerobic Bacterial Blood Stream Infection.

Anaerobic bacteria include Bacteroides, Prevotella, Porphyromonas, Fusobacterium, Peptostreptococcus, Veillonella, and Clostridium.

Anaerobes account for approximately 4% of bacterial BSIs, and are often seen in the context of polymicrobial infection.

67 Given that anaerobes are difficult to recover, and that antimicrobial resistance testing is more labor intensive, antibiotic therapy choices are often made empirically. 67 Unfortunately, antibiotic resistance amongst anaerobes is increasing. 68 However, metronidazole remains highly active against a majority of anaerobes, with only a handful of treatment failures reported, 69 and has a highly favorable pharmacokinetic profile for oral treatment. Oral metronidazole remains an effective choice for many anaerobic BSIs.

Considering the polymicrobial nature of many anaerobic infections, source control is important, and concomitant GNR infection must be ruled out before using metronidazole monotherapy.

Clindamycin has significant anaerobic activity, but Bacteroides resistance has increased significantly in recent years, as high as 26%-44%. 70 Amoxicillin-clavulanate has good anaerobic coverage, but bioavailability of clavulanate is limited (50%), making it inferior for BSI. Bioavailability is also limited for cephalosporins with anaerobic activity, such as cefuroxime.

Moxifloxacin is a fluoroquinolone with some anaerobic coverage and a amoxicillin for chest infection good oral pharmacokinetic profile, but Bacteroides resistance can be as high as 50%, making it a risky empiric choice.

Bacterial BSIs are common and result in significant morbidity and mortality, with high associated healthcare costs.

Although BSIs are traditionally treated with intravenous antimicrobials, many BSIs can be safely and effectively cured using oral antibiotics. When appropriately selected, oral antibiotics offer lower costs, fewer side effects, promote antimicrobial stewardship, and are easier for patients. Ultimately, the decision to use oral versus intravenous antibiotics must consider the characteristics of the pathogen, patient, and drug.

None of the authors report any conflicts of interest.

Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe.

Youkee D, Hulme W, Roberts T, Daniels R, Nutbeam T, Keep J. Time Matters: Antibiotic Timing in Sepsis and Septic Shock. Complications with peripherally inserted central catheters (PICCs) used in hospitalized patients and outpatients: a prospective cohort study.

Allen AW, Megargell JL, Brown DB, Lynch FC, Singh H, Singh Y, Waybill PN.

Venous Thrombosis Associated with the Placement of Peripherally Inserted Central Catheters.

High rate of complications associated with peripherally inserted central venous catheters in patients with solid tumours.

Oral antibiotic therapy of serious systemic infections.

Switch over from tamiflu and amoxicillin intravenous to oral therapy: A concise overview. The Choosing Wisely initiative in infectious diseases.

The Choosing Wisely initiative in infectious diseases.

Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America.

Systemic antibiotic therapy for chronic osteomyelitis in adults. Medication Use in the Transition from Hospital to Home.

Resistance in Gram-Negative Bacteria: Enterobacteriaceae.

Kutob LF, Justo JA, Bookstaver PB, Kohn J, Albrecht H, Al-Hasan MN. Effectiveness of oral antibiotics for definitive therapy of Gram-negative bloodstream infections.

Mombelli G, Pezzoli R, Pinoja-Lutz G, Monotti R, Marone C, Franciolli M Oral vs Intravenous Ciprofloxacin in the Initial Empirical Management of Severe Pyelonephritis or Complicated Urinary Tract Infections: A Prospective Randomized Clinical Trial. Modes of administration of antibiotics for symptomatic severe urinary tract infections. Brigmon MM, Bookstaver PB, Kohn J, Albrecht H, Al-Hasan MN. Impact of fluoroquinolone resistance in Gram-negative bloodstream infections on healthcare utilization.

Analysis of 4758 Escherichia coli bacteraemia episodes: predictive factors for isolation of an antibiotic-resistant strain and their impact on the outcome.

Fluoroquinolone therapy for bloodstream infections caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae.

Comparing the Outcomes of Adults With Enterobacteriaceae Bacteremia Receiving Short-Course Versus Prolonged-Course Antibiotic Therapy in a Multicenter, Propensity ScoreMatched Cohort. Duration of antibiotic treatment for acute pyelonephritis and septic urinary tract infection-- 7 days or less versus longer treatment: systematic review and meta-analysis of randomized controlled trials. Nelson AN, Justo JA, Bookstaver PB, Kohn J, Albrecht H, Al-Hasan MN. Optimal duration of antimicrobial therapy for uncomplicated Gram-negative bloodstream infections.

Evaluating Ciprofloxacin Dosing for Pseudomonas aeruginosa Infection by Using Clinical Outcome-Based Monte Carlo Simulations. Cazaubon Y, Bourguignon L, Goutelle S, Martin amoxicillin petsmart O, Maire P, Ducher M. Are ciprofloxacin dosage regimens adequate for antimicrobial efficacy and prevention of resistance? Pseudomonas aeruginosa bloodstream infection in elderly patients as a simulation case study.

Micek ST, Lloyd AE, Ritchie DJ, Reichley RM, Fraser VJ, Kollef MH.

Pseudomonas aeruginosa Bloodstream Infection: Importance of Appropriate Initial Antimicrobial Treatment. Chamot E, Boffi El Amari E, Rohner P, Van Delden C.

Effectiveness of Combination Antimicrobial Therapy for Pseudomonas aeruginosa Bacteremia.

Active Bacterial Core Surveillance (ABCs) Emerging Infections Program Network Streptococcus pneumoniae, 2013. Clinical presentation, processes and outcomes of care for patients with pneumococcal pneumonia. Bacteremic and nonbacteremic pneumococcal pneumonia. Early switch from intravenous to oral antibiotics in hospitalized patients with bacteremic community-acquired Streptococcus pneumoniae pneumonia.

Effectiveness of early switch from intravenous to oral antibiotics in severe community acquired pneumonia: multicentre

randomised

trial.

The efficacy of penicillin V (phenoxymethyl-penicillin) in the treatment of mild and amoxicillin 500 uses of moderately severe pneumococcal pneumonia. Monotherapy May Be Suboptimal for Severe Bacteremic Pneumococcal Pneumonia. Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia.



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