Urinary Gram-negative Bacteremia IV
to PO Guidelines
This system guideline is to be utilized in the adjustment
of antimicrobials for the treatment of patients with
Enterobacterales bloodstream infections (E-BSI)
secondary to urinary tract infections. It is intended
to provide guidance for optimizing antibiotic therapy
for patients with E-BSI; however, clinical judgment
and individual patient characteristics should always
be considered.
For a comprehensive overview of clinical
considerations and oral stepdown antimicrobial
recommendations, please CLICK HERE and refer
to information in the document on Sharepoint.
Beta-Lactam Allergy Assessment and De-Labeling
• About 90 to 99% of hospitalized patients with
a documented penicillin allergy can tolerate
penicillin therapy.
• Most documented β-lactam allergies can be
de-labeled via patient interview and historical
antibiotic use alone.
• Cross-reactivity between two structurally
dissimilar β- lactams is rarely reported and is at
a similar frequency as a coincidental sulfa allergy.
• Oral graded challenges, in combination with a
multidisciplinary approach to β-lactam allergy
assessment, are safe and effective in de-labeling
inaccurate β-lactam allergies.
• The clinical benefits of de-labeling include,
but are not limited to:
• Shorter hospital lengths of stay
• Lower patient care costs
• Less adverse drug and healthcare-related
events
• Fewer clinical failure rates
For a comprehensive overview of the topic,
please CLICK HERE and refer to information
in the document on Sharepoint.
Duration of Therapy Clinical Guidance
for Uncomplicated Respiratory Tract Infections,
Urinary Tract Infections, and Skin and
Soft-Tissue Infections
Establishing evidence-based recommendations
for duration of antimicrobial therapy is essential
to promoting appropriate antibiotic use, minimizing
the risk of resistance and reducing adverse effects,
ultimately improving patient outcomes. Limiting
unnecessary antibiotic exposure helps prevent
adverse events, such as Clostridioides difficile
infections, while also lowering overall healthcare
costs. Standardizing therapy durations enhances
clinical decision-making and ensures consistency
in patient care across the healthcare system.
These standard antibiotic durations are based on
randomized controlled trials and established
consensus guidelines. Clinical judgement is
important to ensure that the patient being treated
is appropriate for the disease category and
population studied, and to monitor for relapse or
failure to resolve the initial therapy. Thus, longer
durations should be limited to patients who have
an inadequate clinical response to initial therapy.
For a comprehensive overview of recommended
durations of therapy, please CLICK HERE and refer
to information in the document on Sharepoint.
Provider Education Training Manual 17
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