Uncomplicated Gram Neg Bacteremia - I can do oral antibiotics for how long?

Someone finally studied it! There's decent evidence that you can switch to oral antibiotics with good bioavailability (in this study they primarily used Bactrim or quinolones for UTI bugs) when patients with gram negative bacteremia become clinically stable and get the same outcomes as with IV therapy. It's not an RCT, but it's almost 5,000 patients at several centers in a cohort that is closely matched with controls. And it's for hospitalized patients.

 

Association of 30 Day Mortality with Oral Step-Down vs Continued Intravenous Therapy in Patients Hospitalized with Enterobacteriaceae Bacteremia

 

Even better, an actual RCT of 600 patients with gram negative bacteremia, uncomplicated (ie- good source control, no mechanical valves or anything like that), which compared 7 to 14 days of antibiotics and showed no difference.

 

Seven versus fourteen Days of Antibiotic Therapy for uncomplicated Gram-negative Bacteremia: a Non-inferiority Randomized Controlled Trial.

 

It's a good case for doing what feels reasonable - start with IV antibiotics, once patient has been afebrile ~48 hrs and feeling better (no renal failure or stuff like that) and you have sensitivities, then switch to levofloxacin or Bactrim to complete 7 days. No PICC. BAM!