專技 - 藥物治療學題庫下載題庫

Short intravenous course of therapy for 2–3 days followed by oral medications to complete the course of therapy is beneficial to many patients except in conditions of serious/life-threatening infections, in critically ill patients, or in the presence of contraindications to oral administration as in case of nothing per os (NPO) or comatose patients. Selected oral medication produces serum levels comparable to those achieved through IV form with equivalent clinical outcomes as reduction in the length of hospital stay (LOS) and the duration of IV therapy, along with fewer complications, less pa...

Short intravenous course of therapy for 2–3 days followed by oral medications to complete the course of therapy is beneficial to many patients except in conditions of serious/life-threatening infections, in critically ill patients, or in the presence of contraindications to oral administration as in case of nothing per os (NPO) or comatose patients. Selected oral medication produces serum levels comparable to those achieved through IV form with equivalent clinical outcomes as reduction in the length of hospital stay (LOS) and the duration of IV therapy, along with fewer complications, less patient inconvenience, less healthcare costs and earlier hospital discharge.

IV to PO conversion guidelines, a component of ASPs, are implemented in hospitals of developed countries and constitute a strategy in daily practice, whereas few hospitals in Lebanon adopt these programs. Patients fulfilling the predefined criteria for switch are evaluated. These criteria are based on both drug and host factors. Drug factors include high degree of activity against presumed/ known pathogens, high oral bioavailability, low resistance potential, and tolerance with a good safety profile. Host factors require sufficient absorption of an oral antibiotic with no impairment of gastrointestinal tract and stable clinical condition. Improvement of clinical status is evaluated according to temperature, white blood cell count, absence of signs of sepsis, as well as specific criteria for particular infections.

The primary outcome of this study was to evaluate the practice of the utilization of IV antibiotic therapy through an assessment of the switch according to predefined criteria for clinical stability. Criteria for IV to PO switch was defined as patients who had received an IV antibiotic for ≥ 48 hours and were able to tolerate oral therapy; no vomiting or diarrhea or NPO; and clinical improvement with temperature less than 38°C, systolic blood pressure >90 mmHg, heart rate <100 beats per minute, and normal white blood cell count or a decrease of at least 2000 cells/μL over the last 24 hours. A transition to PO antibiotics was not expected when a patient’s condition was unstable and in the case of erratic gastrointestinal absorption that can be due to either severe acute diarrhea or vomiting.

可以由IV switch PO 的標準：

1. 靜脈注射抗生素超過48小時
2. 沒有嘔吐、腹瀉、可以口服治療
3. 體溫低於38°C
4. 收縮壓大於90mmHg、心跳<100 bpm
5. WBC數量正常或減少2000 cells/μL over the last 24 hours

ref : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4320166/