Early Oral Antibiotic Switch in Staphylococcus aureus Bacteraemia: The Staphylococcus aureus Network Adaptive Platform (SNAP) Trial Early Oral Switch Protocol

The SNAP Early Oral Switch Domain-Specific Working Group and SNAP Global Trial Steering Committee for the SNAP Trial Group

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Staphylococcus aureus bloodstream infection (bacteremia) is traditionally treated with at least 2 weeks of intravenous (IV) antibiotics in adults, 3-7 days in children, and often longer for those with complicated disease. The current practice of treating S. aureus bacteremia (SAB) with prolonged IV antibiotics (rather than oral antibiotics) is based on historical observational research and expert opinion. Prolonged IV antibiotic therapy has significant disadvantages for patients and healthcare systems, and there is growing interest in whether a switch to oral antibiotics following an initial period of IV therapy is a safe alternative for clinically stable patients. Protocol: The early oral switch (EOS) domain of the S. aureus Network Adaptive Platform (SNAP) trial will assess early switch to oral antibiotics compared with continued IV treatment in clinically stable patients with SAB. The primary endpoint is 90-day all-cause mortality. Hospitalised SAB patients are assessed at platform day 7 ±2 (uncomplicated SAB) and day 14 ±2 (complicated SAB) to determine their eligibility for randomization to EOS (intervention) or continued IV treatment (current standard of care). Discussion: Recruitment is occurring in the EOS domain of the SNAP trial. As of August 2023, 21% of all SNAP participants had been randomized to the EOS domain, a total of 264 participants across 77 centers, with an aim to recruit at least 1000 participants. We describe challenges and facilitators to enrolment in this domain to aid those planning similar trials.

Original languageEnglish
Pages (from-to)871-887
Number of pages17
JournalClinical Infectious Diseases
Volume79
Issue number4
DOIs
StatePublished - 15 Oct 2024

Funding

FundersFunder number
Te Niwha Infectious Diseases Research Fund
SNAPPY
Counties Manukau Tupu Health Fund
New Zealand Health Research Council of New Zealand20/344
National Health and Medical Research Council2014900
National Institute for Health and Care Research133719
Canadian Institutes of Health Research451092
Medical Research CouncilMC_UU_00004/05
Starship Foundation1184238, ASF2144_WEBB
Center of Research ExcellenceAPP2007007, APP2009736, 1175509
National Medical Research CouncilCTGIIT21nov-0002

    Keywords

    • Staphylococcus aureus (or S. aureus)
    • adaptive platform clinical trial
    • bacteremia (or bacteraemia or bloodstream infection)
    • intravenous antibiotic
    • oral antibiotic

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