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Consequently, there is growing interest in the utilization of oral stepdown therapy, defined as the transition of intravenous therapy to an active oral agent, for this indication. This review highlights available literature examining oral stepdown in adult patients with BSI due to commonly encountered Gram\u2010positive pathogens, including <jats:italic>Staphylococcus aureus<\/jats:italic>, <jats:italic>Streptococcus<\/jats:italic> spp., and <jats:italic>Enterococcus<\/jats:italic> spp. Support for oral stepdown in this setting is primarily derived from observational studies subject to selection bias. Nevertheless, this treatment strategy exhibits promising potential in carefully selected patients as it is consistently associated with reductions in hospital length of stay without jeopardizing clinical cure or survivability. Prospective, randomized trials are needed for validation of oral stepdown in Gram\u2010positive BSI and to identify the optimal patient population and regimen.<\/jats:p>","DOI":"10.1002\/phar.2775","type":"journal-article","created":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T03:18:41Z","timestamp":1675307921000},"page":"247-256","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Oral stepdown in Gram\u2010positive bloodstream infections: A step in the right direction"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1468-8267","authenticated-orcid":false,"given":"Kaylee E.","family":"Caniff","sequence":"first","affiliation":[{"name":"Anti\u2010Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5469-1228","authenticated-orcid":false,"given":"Nicholas","family":"Rebold","sequence":"additional","affiliation":[{"name":"Anti\u2010Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University  Detroit Michigan USA"},{"name":"Department of Clinical &amp; Administrative Pharmacy Sciences, College of Pharmacy Howard University  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2220-0081","authenticated-orcid":false,"given":"Michael J.","family":"Rybak","sequence":"additional","affiliation":[{"name":"Anti\u2010Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University  Detroit Michigan USA"},{"name":"Division of Infectious Diseases, School of Medicine Wayne State University  Detroit Michigan USA"},{"name":"Department of Pharmacy Detroit Receiving Hospital  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,2,18]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/1469-0691.12195"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2018.03.005"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2019.10.031"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/1120009X.2018.1516272"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/2049936119893576"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2021.10.007"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofz386"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000000330"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000217961.75225.E9"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31821e87ab"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2012.04.010"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.4103\/0976-500X.130042"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2016.07.013"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofz364"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2019.05.012"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2018.11.012"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000005662"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6809e1"},{"issue":"4","key":"e_1_2_6_20_1","first-page":"S246","article-title":"Patients at risk of complications of Staphylococcus aureus bloodstream infection","volume":"48","author":"Rio A","year":"2009","journal-title":"Clin Infect Dis"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mib.2020.02.005"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciq146"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000296"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2015.09.037"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ120"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.3958"},{"key":"e_1_2_6_27_1","unstructured":"BoucherH CoreyG FillerS et al.Appropriateness of two\u2010week therapy for catheter\u2010relatedS. aureusbacteremia [abstract number L\u20101204]. 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