Low-risk Staphylococcus aureus bacteremia Staphylococcus aureus bacteremia Cephalexin Levofloxacin Oral switch therapy
Conditions
Interventions
Oral switch to cephalexin or levofloxacin (CrCl-adjusted dose) after 7 days of intravenous antibiotic
Total duration of treatment 14 days starting from first documented negative hemoculture,14 days of
Experimental Drug,Active Comparator Drug
Oral switch,Standard IV
Sponsors
Faculty of Medicine, Chiang Mai University
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Inclusion criteria
Inclusion criteria: 1. Patients diagnosed with MSSA bloodstream infection with a low risk of complications, who must have at least one blood culture specimen positive for MSSA. 2. Patients must receive appropriate antibiotic therapy within no more than 72 hours from the time the first blood sample that later yielded a positive culture was collected. In this context, antibiotics considered appropriate for treating MSSA include Penicillinase-resistant penicillins, such as flucloxacillin, cloxacillin, beta-lactam plus beta-lactamase inhibitor agents, such as ampicillin-sulbactam, piperacillin-tazobactam, All cephalosporins except ceftazidime, All carbapenems, All fluoroquinolones, Tetracyclines, such as doxycycline, tigecycline, Glycopeptides, such as vancomycin, teicoplanin, telavancin, Clindamycin, Trimethoprim-sulfamethoxazole, Linezolid, Daptomycin, Macrolides 3. Patients must have a negative follow-up blood culture after receiving appropriate treatment for 24-96 hours.
Exclusion criteria
Exclusion criteria: 1. Patients who have symptoms or signs of deep-seated MSSA infection before entering the randomization process, defined as the following conditions (Endocarditis, Pneumonia, Infected implant, Osteomyelitis, Undrained abscess, Empyema) 2. Patients who still have septic shock during the 4 days before entering the randomization process. 3. Patients with persistent fever, defined as a measured body temperature of 38 C or higher during the 2 days before entering the randomization process. 4. Patients with persistent bacteremia, with blood cultures positive for MSSA despite having received appropriate antibiotic therapy for at least 72 hours. 5. Patients who have an intravascular catheter left in place for more than 4 days from the date of the first positive culture, in cases of catheter-related MSSA bloodstream infection (catheter-related bloodstream infection). 6. Patients who are likely to develop complications from MSSA bloodstream infection, including 6.1 Patients previously diagnosed with MSSA bloodstream infection within the past 3 months 6.2 Patients with underlying diseases or medical treatments causing severe immunocompromised conditions, including primary immunodeficiency disorders, neutropenia, with an absolute neutrophil count (ANC) less than 500 cells/cu.mm. before entering the randomization process, or expected to develop neutropenia during the study 6.3 People living with HIV with a CD4 lymphocyte count less than 200 cells/cu.mm. 6.4 Patients receiving prednisolone more than 1 MKD (or equivalent) for at least 4 weeks, or planning to start such steroid therapy during the study 6.5 Patients receiving at least two immunosuppressive agents with different immunosuppressive mechanisms of action 6.6 Patients who have undergone hematopoietic stem cell transplantation within the past 6 months, or are likely to undergo transplantation during the study 6.7 Patients who have undergone solid organ transplantation, or are likely to undergo transplantation during the study Patients who have received biologic therapy within the past year 6.8 Intravenous drug users (IVDU) 6.9 Patients with a prosthetic heart valve and/or a deep-seated vascular graft in the body 7. Patients with other concurrent infections (co-infection) during the same period.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Composite outcome 30 days mortality rate, treatment failure rate | — |
Secondary
| Measure | Time frame |
|---|---|
| mortality rate 30 days mortality rate,deep-seated infection 30 days occurrence of deep-seated infection,bacteremia 30 days relapse of bacteremia,safety outcome 30 days adverse events during treatment | — |
Countries
Thailand
Contacts
Public ContactNatthapong Suthammopasut
Faculty of Medicine, Chiang Mai University
Outcome results
None listed