Patient-reported Perceptions, Experiences, and Preferences Around Intravenous and Oral Antibiotics for the Treatment of Staphylococcus aureus Bacteremia: A Descriptive Qualitative Study

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BACKGROUND: There is growing evidence to support partial oral antibiotic treatment of severe infections such as Staphylococcus aureus bacteremia, but clinical practice is slow to adopt this paradigm. We know little about how patients with severe infection experience and perceive intravenous and oral antibiotics in terms of quality of life and clinical effectiveness. We performed a qualitative study to elicit patients' views on treatment with intravenous and oral antibiotics, aiming to provide insights that could inform collaborative treatment decision-making. METHODS: We conducted semi-structured interviews with participants in the Staphylococcus aureus Network Adaptive Platform trial pharmacological sub-study PR-O-SNAP by telephone, in person, or via video conferencing. Interviews were recorded, transcribed and coded, and used to analyze and identify themes. Interviews occurred in 2 phases between November 2024 and January 2025, with interim analysis to refine interview questions between each phase. RESULTS: We interviewed 17 patients who had received sequential intravenous then oral antibiotics for treatment of Staphylococcus aureus bacteremia. Overall, most participants preferred oral antibiotics for their convenience, which enabled improved mobility and independence, despite a perception that oral regimens were more complex and likely to cause side effects, and that intravenous antibiotics were more effective. CONCLUSIONS: Choosing a route of antibiotic administration for treatment of severe infection is a nuanced decision which should incorporate not just a patient's clinical status but also their preferences and personal context. Patient convenience and functional goals should be considered in treatment discussions between clinicians and patients.

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