Following on from Jude’s post earlier in the week and subsequent Journal Club discussion on the role of patients in hand hygiene, I thought I’d follow suit by look at a qualitative study about patient views on IV vs. oral antibiotics for S. aureus BSI. The short answer is that patients preferred the oral choice, even though this was view as more complicated and less effective than IV antibiotics!

S. aureus bacteraemia (SAB) remains a very serious infection, with attributable mortality for an in-hospital episode around 20%. Evidence suggests that an ‘early oral switch’ when things are looking up following initial IV antibiotics is safe and effective, and in some ways advantageous. But this practice is struggling to make it into guidelines and practice.

This international collaborative (featuring authors from New Zealand, Australia, Canada, the Netherlands, and the UK) set out to determine some patient views on the prospects of switching them onto oral antibiotics when being treated for SAB. Semi-structured interviews were untaken with 17 patients undergoing treatment for SAB in three New Zealand hospitals.

The key themes that emerged from these interviews were:

• Convenience and practicality of oral antibiotics in daily life. Unsurprisingly, patients found oral antibiotics to be more convenient. The presence of a PICC in particular was really annoying for patients and interfered with their daily lives.
• Tolerability and complexity of oral antibiotic regimens. Side-effects (such as gastro-intestinal upsets) were more commonly experienced with oral antibiotics, along with other unwanted effects like unpleasant taste and smell.
• Perceptions of comparative efficacy of IV versus oral antibiotics. Most patients believed that IV antibiotics were more likely to be effective than oral.
• Individual preferences for route of administration. Patient preference for a route of administration was personalised, influenced by their clinical status, personal values, and life context.

So, what are we to make of this and why does it matter? This was a detailed account of the views of 17 patients in New Zealand who had recovered from SAB. Do their views represent those of others? Especially those at a different course of the disease? I suspect patients who are just turning a corner on their IV treatment of SAB would be more reluctant to switch to oral antibiotics than patients who are looking back on successful therapy.

Overall, an interesting study, and provides weight to moving forward with an early oral switch for SAB.