We all know the facts
about antibiotic resistance.

Antibiotic resistance is on the rise. Hospital admissions for infections are on the rise.1,2
It's time for our treatment options to rise up and face this challenge.

You and your patients deserve more options.
Learn why.

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2 million Americans will acquire antibiotic-resistant infections this year. At least 23,000 will die.7
antibiotic resistance is growing over time
1945 Nobel lecture
Alexander Fleming It is not difficult to make microbes resistant in the laboratory...and the same thing has occasionally happened in the body.
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AS ANTIBIOTIC RESISTANCE RISES, OUR TREATMENT OPTIONS ARE GETTING NARROWER

Antibiotic-resistant infections and appropriate antibiotic use.
The antibiotic revolution has transformed medicine. But even Alexander Fleming—who pioneered it with his discovery of penicillin—warned about the dangers of antibiotic resistance as early as 1945, in his Nobel Prize acceptance speech.3

1945 Nobel lecture
Alexander Fleming It is not difficult to make microbes resistant in the laboratory...and the same thing has occasionally happened in the body.

Today, our use of antibiotics has resulted in resistance for nearly all antibiotics developed to treat serious infections since the 1940s. These antibiotic resistant microorganisms have been described by world leaders as "nightmare bacteria" that "pose a catastrophic threat" to people in every country in the world.1 In a global survey that gathered data from 114 member countries, the WHO observed very high resistance rates in both hospital-acquired and community-acquired infections in every region. Astoundingly, the data showed that resistance rates of E. coli, K. pneumoniae, and S. aureus to commonly used antibiotics frequently exceeded 50 percent.4

Antibiotic use and today’s reality.
As you know, it’s often necessary to treat patients with serious infections empirically while you’re waiting for the causative microbe to be identified. But it isn’t always feasible to wait for results to come in from the lab, especially if they turn out to be inconclusive or polymicrobial, as often happens.5,6

Rise up. Join the fight against antibiotic resistance.

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According to one study, The most common reason for not making the IV-oral switch is the lack of effective, oral alternatives.15
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RISING HOSPITAL ADMISSIONS ARE BECOMING INCREASINGLY PROBLEMATIC

Admitting the problem: the hospital stay burden.
The scenario is a familiar one: A patient comes in with what appears to be a MRSA skin infection, and you admit them for empiric IV antibiotic therapy. How optimal is this? Are patients staying in the hospital longer than they need to? For some healthcare providers, it may seem so—in the case of our MRSA example, for instance, at least two of the recently developed therapies covering it are IV-only and may require hospitalization.8,9

For a variety of common infectious diseases, hospital admissions are high in both number and cost. Community-acquired pneumonia accounts for 600,000 to 1.1 million hospitalizations per year in the United States, with an annual cost of over $17 billion.10 A study looking at admissions for acute bacterial skin and skin structure infections (ABSSSIs) from 2005-2011, revealed an average stay of 5.2 days at a cost of approximately $10,000 per stay.11 Another study showed that ABSSSI admissions increased by 73 percent between 1997 and 2011.2

The risks of IV antibiotics and length of hospital stay.
Of course, this isn't just about the material costs of stay and treatment. It's also about the health of our patients. Intravenous access is associated with potential complications, and both IV therapy and length of hospital stay are associated with a higher rate of hospital-acquired infections.12,13,14,15

FOR PATIENTS WHO ARE STABLE AND ABLE TO TOLERATE ORAL TREATMENT, TRANSITIONING FROM IV TO ORAL THERAPY CAN SHORTEN THE LENGTH OF HOSPITAL STAY, LOWER HEALTH CARE COSTS, AND REDUCE POTENTIAL COMPLICATIONS ARISING FROM IV ACCESS.13,16

Moreover, up to 80 percent of patients prefer to be treated at home.16 So, what’s stopping us?

ADMISSIONS ARE A CONCERN

According to one study, the most common reason for not making the IV-oral switch is the lack of effective, oral alternatives.15

PATIENTS ON EMPIRIC ANTIBIOTIC THERAPY SHOULDN'T HAVE TO STAY IN THE HOSPITAL LONGER THAN NEEDED.
switching from IV to oral antibiotics
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THE IV-TO-ORAL ANTIBIOTIC SWITCH: IS IT OPTIMAL?

A little switch, a big change: why bioequivalence matters.
The idea seems simple enough. Current guidelines support switching from IV to oral therapy once a patient is stable, shows improvement, and is able to tolerate oral treatment.16 But this doesn't always happen. As far back as 2003, a study of 89 patients with MRSA showed that almost 70 percent of patients met the criteria for IV-to-oral switch therapy. How many of them actually received oral treatment? Just 10 percent.17 It's been a while since then—yet very little has changed. Why?

More bioequivalent oral options may help fight resistance.
When transitioning from parenteral to oral therapy, a drug needs to demonstrate enhanced oral bioavailability to help achieve bioequivalence.13 Too often, this option isn’t available to healthcare providers. But when it is, more physicians might be ready to make the transition18 for stable patients able to tolerate oral treatment.16 In a 12-month intervention study designed to encourage switching patients from IV to oral therapy, researchers found that the patients who were successfully switched to oral antibiotics were more likely to have been started on an antibiotic with both IV and oral formulations.18

And that could lead to shorter hospital stay, lower healthcare costs, and reduced health risks for hospitalized patients.13

ORAL OPTIONS ARE IMPORTANT
WE NEED BETTER ORAL ANTIBIOTIC TREATMENT OPTIONS TO HELP SHORTEN HOSPITAL STAY.13
As antibiotics are not being developed at the rate they used to be, as bacteria become increasingly resistant to antibiotics we already have, we don't really have as many antibiotic choices as we did in the past. —Dr. Niedermann
I'm glad that there is renewed interest in newer classes and different classes of antimicrobials, because they don't last forever. —Dr. Kaye
I think that new antibiotics should be a priority for public health because there are many infections for which we are running out of options. This is particularly true for oral antibiotics. So good oral agents, I think, are very important. —Dr. Sakoulas
The biggest problem with antibiotic use is probably having oral agents that you can use safely for resistant or multidrug-resistant organisms. —Dr. Anstead

REFERENCES

1. CDC. Antibiotic resistance threats in the United States, 2013. http://www.cdc.gov/drugresistance/threat-report-2013. 2. Pfuntner A, Wier LM, Stocks C. HCUP Statistical Brief #162. Most Frequent Conditions in U.S. Hospitals, 2011. 2013. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb162.pdf 3. Fleming A. Penicillin. (Nobel Lecture). 1945. https://www.nobelprize.org/nobel_prizes/medicine/laureates/1945/fleming-lecture.pdf 4. WHO. Antimicrobial Resistance: Global Report on Surveillance. 2014. http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf?ua=1 5. Liu P, Ohi C, Johnson J, Williamson J, Beardsley J, Luther V. Frequency of empiric antibiotic de-escalation in an acute care hospital with an established Antimicrobial Stewardship Program. BMC Infectious Diseases. 2016;16:751. doi:10.1186/s12879-016-2080-3. 6. Tabah A, Cotta MO, Garnacho-Montero J, et al. A Systematic Review of the Definitions, Determinants, and Clinical Outcomes of Antimicrobial De-escalation in the Intensive Care Unit. Clin Infect Dis 2016; 62 (8): 1009-1017. doi:10.1093/cid/civ1199. 7. CDC. Antibiotic / Antimicrobial Resistance, 2017. https://www.cdc.gov/drugresistance/. 8. Ceftaroline, NDA 200327. Drugs@FDA: FDA Approved Drug Products. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&applno=200327. 9. Dalbavancin, NDA 021883. Drugs@FDA: FDA Approved Drug Products. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&applno=021883. 10. McLaughlin JM, Johnson MH, Kagan SA, Baer SL. Clinical and economic burden of community-acquired pneumonia in the Veterans Health Administration, 2011: a retrospective cohort study. Infection. 2015;43(6):671-680. doi:10.1007/s15010-015-0789-3. 11. Kaye KS, Patel DA, Stephens JM, et al. Rising United States Hospital Admissions for Acute Bacterial Skin and Skin Structure Infections: Recent Trends and Economic Impact. Planet PJ, ed. PLoS ONE. 2015;10(11):e0143276. doi:10.1371/journal.pone.0143276. 12. Merck Manual. Problems Due to Hospitalization. 2017. http://www.merckmanuals.com/home/special-subjects/hospital-care/problems-due-to-hospitalization. 13. Dellit TH, Owens RC, McGowan JE, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship. Clin Infect Dis 2007; 44 (2): 159-177. doi:10.1086/510393. 14. Li HK, Agweyu A, English M, Bejon P. An Unsupported Preference for Intravenous Antibiotics. PLoS Medicine. 2015;12(5):e1001825. doi:10.1371/journal.pmed.1001825. 15. Hassan M, Tuckman HP, Patrick RH, et al. Hospital length of stay and probability of acquiring infection. International Journal of Pharmaceutical and Healthcare Marketing. 2010;4(4):324-38. doi:10.1108/17506121011095182. 16. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clin Infect Dis 2007; 44 (Supplement_2): S27-S72. doi: 10.1086/511159. 17. Conly JM, Stiver HG, Weiss KA, et al. A retrospective analysis of practice patterns in the treatment of methicillin-resistant Staphylococcus aureus skin and soft tissue infections at three Canadian tertiary care centres. The Canadian Journal of Infectious Diseases. 2003;14(6):315-321. 18. Mertz D, Koller M, Haller P, et al. Outcomes of early switching from intravenous to oral antibiotics on medical wards. Journal of Antimicrobial Chemotherapy. 2009;64(1):188-199. doi:10.1093/jac/dkp131.