TY - JOUR AU - Emmanuel Martinez, Aurélien AU - Scheidegger, Claude AU - Bättig, Veronika AU - Erb, Stefan PY - 2020/06/21 Y2 - 2024/03/28 TI - Oral antibiotic therapy in people who inject drugs (PWID) with bacteraemia JF - Swiss Medical Weekly JA - Swiss Med Wkly VL - 150 IS - 2324 SE - Review article: Biomedical intelligence DO - 10.4414/smw.2020.20259 UR - https://smw.ch/index.php/smw/article/view/2805 SP - w20259 AB - <p><p>Bacterial infections are a major cause of morbidity and mortality in people who inject drugs (PWID). Patients with bacteraemia have a particularly high risk of complications and are usually treated with intravenous antibiotics. Intravenous treatment is challenging in certain PWID because of difficult venous access and a high rate of catheter-associated complications. Therefore, oral treatment alternatives must be considered.</p> <p>This review discusses the potential options for oral antimicrobial treatment of gram-positive and gram-negative bacteraemia in PWID and the evidence for them.</p> <p>Data on oral antibiotic treatment of bacteraemia in PWID is scarce. Whenever possible, a course of intravenous antibiotic treatment should precede the switch to an oral regimen. For <em>Staphylococcus aureus</em> bacteraemia, there is growing evidence that initial intravenous antibiotics can be switched to oral treatment (e.g., a fluoroquinolone and rifampin or linezolid) when the patient is clinically stable and source control has been achieved. However, regimen selection remains challenging due to pharmacokinetic/pharmacodynamic issues, potential toxicity and drug-drug interactions of oral antibiotics. For some streptococcal bacteraemia, oral amoxicillin is probably a reasonable option. The best existing evidence for oral antibiotic treatment is for gram-negative bacteraemia, which, if susceptible, can be treated successfully with oral fluoroquinolones. Oral antibiotic options for fluoroquinolone-resistant gram-negative bacteraemia are very limited, although in selected patients oral trimethoprim-sulfamethoxazole can be considered.</p> <p>In conclusion, treatment of bacteraemia in PWID remains very complex, and an interdisciplinary approach is essential in order to select the best therapy for this vulnerable group of patients.</p></p> ER -