Name: Evaluation of Amoxicillin-Clavulanate as Oral Step-Down Therapy for Gram-Negative Bloodstream Infections
Start: 2025-04-24T09:30:00-0400
End: 2025-04-24T09:45:00-0400

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Thursday April 24, 2025 9:30am - 9:45am EDT

Parthenon 1

Title: Evaluation of Amoxicillin-Clavulanate as Oral Step-Down Therapy for Gram-Negative Bloodstream Infections

Authors: William W. Feese; Jennifer Liriano-Suarez; Jessica Arnold; Hayden W. Caldwell; Brandon K. Hawkins; Samantha D. Walker, ; Helen Ding

Objective: Evaluate the impact of BID versus TID dosing on the efficacy of amoxicillin-clavulanate as oral step-down therapy for gram-negative bloodstream infections.

Self Assessment Question: For a patient transitioning to amoxicillin-clavulanate for treatment of a gram-negative bloodstream infection, what is the most appropriate dosing regimen?

Background: Gram-negative bloodstream infections (BSIs) are a leading cause of hospitalizations in North America, with Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa being the most common causative organisms. Historically, gram-negative BSIs have been treated exclusively with IV antibiotics, but recent evidence suggests that oral agents, such as beta-lactams or fluoroquinolones, are effective as oral step-down therapy to complete the treatment course. The impact of amoxicillin-clavulanate twice daily (BID) versus three times a day (TID) dosing frequency on clinical outcomes for bloodstream infections remains unclear.

Methods: This was a single-center, retrospective cohort study of adult patients with gram-negative BSIs who received amoxicillin-clavulanate as oral step-down therapy at a 710-bed academic medical center between May 1, 2019 and June 30, 2024. The co-primary outcomes were 30-day all-cause mortality and 30-day incidence of infection recurrence.

Results: Amoxicillin-clavulanate BID and TID were similar with regard to the co-primary outcomes. For the primary outcome, 30-day all-cause mortality was experienced by 5 (2.8%) patients in the BID and no patients in the TID group (p = 1.00). 30-day recurrence was experienced by 7 (3.8%) of the BID group patients compared to 1 patient (2.9%) of the TID group (p = 1.00). In the subgroup analysis, there was no statistically significant difference between Body Mass Index (BMI) ≥ 30 kg/m2 and BMI < 30 kg/m2 or complicated and uncomplicated blood stream infections when comparing amoxicillin-clavulanate BID and TID dosing.

Conclusion: Both Amoxicillin-clavulanate BID and TID dosing frequencies demonstrate efficacy as oral (PO) stepdown therapies for patients with gram-negative BSI. With low rates of mortality and recurrence seen with PO antibiotic therapy, future studies should address the total duration of antibiotic therapy for gram-negative BSI.

Presenters

William Feese

PGY-1 Pharmacy Resident, University of Tennessee Medical Center

Dr. Feese was born and raised in Lexington, Kentucky. He completed his Bachelor of Science in Pharmaceutical Sciences with an emphasis in Health Humanities from the esteemed St. Louis College of Pharmacy and his Doctor of Pharmacy from the University of Health Sciences and Pharmacy... Read More →

Evaluators