Early Oral Antibiotic Switch in <i>Staphylococcus aureus</i> Bacteraemia: The <i>Staphylococcus aureus</i> Network Adaptive Platform (SNAP) Trial Early Oral Switch Protocol
Dana de Kretser, Jocelyn Mora, Max Bloomfield, Anita J Campbell, Matthew P. Cheng, Stephen Guy, M.P.M. Hensgens, Shirin Kalimuddin, Todd C. Lee, Amy Legg, Robert K. Mahar, Michael Marks, Julie Marsh, Anna McGlothin, Susan C. Morpeth, Archana Sud, Jaap ten Oever, Dafna Yahav, Marc Bonten, Asha C Bowen, Nick Daneman, Sebastiaan J. van Hal, G Hériot, Roger Lewis, David Chien Lye, Zoe McQuilten, David L Paterson, James O. Robinson, Jason A. Roberts, Matthew Scarborough, Steve Webb, Lynda Whiteway, Steven Y. C. Tong, Joshua S. Davis, Genevieve Walls, Anna L. Goodman, Julie Marsh, Steven Y. C. Tong, Joshua S. Davis, Anna L. Goodman, Genevieve Walls, Susan C. Morpeth, M.P.M. Hensgens, Jocelyn Mora, Dafna Yahav, Anna McGlothlin, Matthew P. Cheng, for the SNAP Trial Group, Nick Anagnostou, Sophia Acrhuleta, Eugene Athan, Lauren Barina, Emma Best, Katie Brett, Hannah J. Burden, Peter Daley, Jane Davies, Productora De, Yael Dishon‐Benattar, Katie L. Flanagan, Jennifer Grant, Dan Gregson, Kate Grimwade, James Hatcher, Andrew Henderson, Dina Janković, Jennie Johnstone, I Russel Lee, Ka Lip Chew, Martin Llewelyn, Anne‐Grete Märtson, Colin McArthur, Diana McNeil, Sarah Metcalf, Clare Nourse, Matthew O’Sullivan, Lina Petrella, Sarah Pett, Benjamin A. Rogers, James Heng Chiak Sim, Marta Soares, Neil Stone, Robert Tilley, Rebecca Turner, Viliame Tutone, Jonathan Underwood, Lesley Voss, Rachel Webb, Heather L. Wilson, Terence Wuerz
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.