Antibiotics for Gram-Negative Bacteremia: How Early to Switch to Oral from IV?

A recent trial showed that, in patients with gram-negative bacteremia, switching to oral antibiotics after 3 to 5 days was not clinically inferior to continuing intravenous (IV) treatment (NEJM JW Infect Dis Nov 8 2023 and Clin Microbiol Infect 2023 Oct 17; [e-pub]). Now, Danish investigators used target trial emulation analysis in a cohort study to compare 90-day mortality in patients with uncomplicated gram-negative bacteremia who were switched to oral therapy (OT) within 4 days of blood culture results versus those who continued IV therapy (IVT) for at least 5 days.

Among 914 patients (44% female; median age, 74.5 years), 47.4% were in the OT group and 52.6% were in the IVT group. Those in the OT group were younger (73 vs. 76 years) and m…