In the world of inpatient infectious disease (ID) consults, a recurring challenge surfaces: the hesitation to shift from IV to oral antibiotics, even when clinical evidence supports it. This dialogue between an ID consultant and a surgeon, as shared by Dr. Paul Sax in NEJM Journal Watch, perfectly illustrates the tension.
While both parties aim for the best patient outcomes, there’s often a bias favoring IV antibiotics for severe infections. The underlying concern? A fear that oral therapy isn’t “aggressive” enough, despite robust evidence proving its efficacy in many cases.
This debate goes beyond tradition it touches on patient safety, healthcare costs, and quality of life. Home IV therapy isn’t without risks: catheter infections, clots, lab errors, and logistical issues. Yet, these challenges often remain invisible to surgeons since ID specialists typically manage OPAT (Outpatient Parenteral Antimicrobial Therapy).
The key takeaway: Bacteria don’t care how antibiotics are delivered only that they’re effective.
