A while back, my Dad was in the ER with pneumonia- He drove himself there after a week or so of generalized symptoms.
Doc: Looks like we should admit him for a day or two.
Me: Why?
Doc: IV antibiotcs.
Me: Which one?
Doc: Levaquin.
Me: Given the excellent bio-availability of PO Levaquin, why not send him home with a prescription?
Doc: He might get worse despite treatment.
Me: I'll bring him back.
Doc: Sounds like a plan.
I work in an ER, and give a lot of IV antibiotics.
Often on admitted patients, and periodically have to start a line for one administration. (I really want to tell the patient to refuse, and request PO.)
Obviously, this is needed for PTs who cannot tolerate PO.
Other than that, is there any evidence anywhere that the preference for IV abx is supported?
One argument is the high concentrations needed for certain infections. But that can be maintained by appropriate dosing.
Another argument is for more rapid absorption. Maybe. This might be the case for a rapidly progressing infection, which is rarely the case. And, I would argue that on average, the patient getting IV abx (in the ER) reaches effective plasma concentration more slowly due to:
Starting IV
Obtaining the med, which may need to come from pharmacy
Actual duration of administration
Setting up a pump, and inevitable pump issues
I strongly suspect that, if studied, on average patients getting PO abx reach effective plasma concentrations earlier.
So- anybody know of any good evidence supporting the widespread practice of IV abx over PO?
