There’s a lot of magical thinking about IV antibiotics

The fact is, the bug doesn’t care how the drug got in. It only cares how much drug gets to it!

There’s actually only a few reasons you ever have to give them IV over oral. Let’s take a look at some #FOAMed 1/4

1. Speed. If you have a life/limb threatening infection and need peak plasma levels in seconds/minutes, not minutes to hours (Sepsis, nec fasc etc)

2. Absorption. If there are concerns about poor gut function and not absorbing oral drugs properly (enteropathy, sepsis etc) 2/4

3. No gut access. Patient is nil by mouth (duh)

4. Coverage. There are no oral options to sufficiently cover a particularly resistant bacteria (e.g. Pseudomonas, ESBLs)

5. Dose. You need to give such a whopping dose it wouldn’t be tolerated orally 3/4

Some drugs have such amazing oral absorption that giving them IV if the patient can swallow them is criminal!

Metronidazole, Rifampicin, Doxycycline, Ciprofloxacin, Clindamycin (also all generally have amazing tissue penetration!)

IV ain’t magic. Dose it oral when you can! 4/4