Amoxicillin clavulanate 875

Competing interests: Elissa Abrams has received an unrestricted educational grant from Novartis, outside the submitted work.

Adverse effects of amoxicillin may be potentially under-reported. the Oncology Nurse Advisor take: Amoxicillin is a widely used antibiotic in the penicillin group of drugs. It is used to treat bacterial infections in patients with cancer, and may be used as prophylaxis in some patients.

In a systematic review, researchers conducted a review of controlled trials to assess potential harms related to amoxicillin use. The review included a total of 45 trials, featuring a total of 10,519 participants.

The researchers found that almost twice as many patients receiving amoxicillin had diarrhea compared with patients receiving placebo, and diarrhea was more than three times more likely among participants receiving amoxicillin-clavulanate. An association between candidiasis and amoxicillin-clavulanic acid use was also observed. However, the authors acknowledge a limitation to their study.

All the trials measured efficacy

rather

Not only that, but these adverse effects could also be under-reported, leading to a high prevalence of prescriptions. When are Oral Antibiotics a Safe and Effective Choice for Bacterial Bloodstream Infections? Hale, MD, University of Vermont Medical Center, Infectious Disease Unit, 111 Colchester Avenue, Mailstop 115 SM2.

Burlington, VT 05401; Telephone: 802-847-2264; Fax: 802-847-5322; E-mail: [email protected] Abstract.

Bacterial bloodstream infections (BSIs) are a major cause of morbidity and mortality in the United States. Traditionally, BSIs have been managed with intravenous antimicrobials. However, whether intravenous antimicrobials are necessary for the entirety of the treatment course in BSIs, especially for uncomplicated episodes, is a more controversial matter.

Patients that are clinically stable, without signs of shock, or have been stabilized after an initial septic presentation, may be appropriate candidates for treatment of BSIs with oral antimicrobials. There are risks and costs associated with extended courses of intravenous agents, such as the necessity for long-term intravenous catheters, which entail risks for procedural complications, secondary infections, and thrombosis.

Oral antimicrobial therapy for bacterial BSIs offers several potential benefits.

When selected appropriately, oral antibiotics offer lower cost, fewer side effects, promote antimicrobial stewardship, and are easier for patients.

The decision to use oral versus intravenous antibiotics must consider the characteristics of the pathogen, the patient, and the drug. In this narrative review, the authors highlight areas where oral therapy is a safe and effective choice to treat bloodstream infection, and offer guidance and cautions to clinicians managing patients experiencing BSI.

Bacterial bloodstream infections (BSIs) are a major cause of morbidity and mortality in the United States.

Approximately 600,000 BSI cases occur annually, resulting in 85,000 deaths, 1 at a cost exceeding $1 billion. 2 Traditionally, BSIs have been managed with intravenous antimicrobials, which rapidly achieve therapeutic blood concentrations, and are viewed as more potent than oral alternatives. Indeed, for acutely ill patients with bacteremia and sepsis, timely intravenous antimicrobials are lifesaving. However, whether intravenous antimicrobials are essential for the entire treatment course in BSIs, particularly for uncomplicated episodes, is controversial. Patients that are clinically stable or have been stabilized after an initial septic presentation may be appropriate candidates for treatment with oral antimicrobials. There are costs and risks associated with extended courses of intravenous agents, such as the necessity for long-term intravenous catheters, which entail risks for procedural complications, secondary infections, and thrombosis. A prospective study of 192 peripherally inserted central catheter (PICC) episodes reported an overall complication rate of 30.2%, including central line-associated BSIs (CLABSI) or venous thrombosis.

4 Other studies also identified high rates of thrombosis 5 and PICC-related CLABSI, particularly in patients with malignancy, where sepsis-related complications approach 25%.

6 Additionally, appropriate care of indwelling catheters requires significant financial and healthcare resources. Oral antimicrobial therapy for bacterial BSIs offers several potential benefits.

Direct economic and healthcare workforce savings are expected to be significant, and procedural and catheter-related complications would be eliminated.

7 Moreover, oral therapy provides antimicrobial stewardship by reducing the use of broad-spectrum intravenous agents.