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Guidelines
IV to PO Conversion Guide

IV to PO Conversion Guide

Antibiotic IV to PO, 100% Oral Equivalent

If an IV antibiotic with a 100% PO bioequivalent is ordered:

  • Based on charted clinical data, conversion to the PO antibiotic is appropriate
  • As long as no GI absorption issues exist, the same drug/dose given by oral route provides identical exposure to the IV route
  • Levofloxacin
  • Metronidazole
  • Linezolid
  • Clindamycin
  • Azithromycin
  • Doxycycline
  • Fluconazole
  • Rifampin
  • Active Antibiotics for >24 hours
  • Afebrile >24 hours
  • Systolic Blood Pressure ≥85 x 24 hours
  • WBC between 3.5 and 11
  • PO diet ordered
  • Active PO medications ordered
  • No vasopressors orders
  • No active antiemetic orders

Antibiotic IV to PO Conversion Clinically Appropriate

Based on charted clinical data, conversion to a PO antibiotic equivalent may be appropriate

  • Ampicillin
  • Ampicillin/sulbactam
  • Piperacillin/tazobactam
  • Cefazolin
  • Ceftriaxone
  • Ceftazidime
  • Cefepime
  • Daptomycin
  • Vancomycin
  • Linezolid
  • Meropenem
  • Active Antibiotics for >24 hours
  • Afebrile >24 hours
  • Systolic Blood Pressure ≥85 x 24 hours
  • WBC between 3.5 and 11
  • PO diet ordered
  • Active PO medications ordered
  • No vasopressors orders
  • No active antiemetic orders
  • CNS Infections
  • Cystic Fibrosis
  • Neutropenic Fever
  • Osteomyelitis (Consult ID for PO options)
  • Endocarditis
  • Septic Arthritis/Prosthetic Joint Infection (Consult ID for PO options)
  • Bacteremia (Consult ID or Contact ASP pharmacist for assistance with PO options)

See Individual Disease State Guidelines for Infection Specific PO Conversion Recommendations

IV Antibiotic PO Equivalent
Ampicillin Amoxicillin (dose dependent on indication)
Ampicillin/Sulbactam Amoxicillin-clavulanate 875 mg BID
Piperacillin/Tazobactam Amoxicillin-clavulanate 875 mg BID*
Cefazolin Cephalexin 500 mg TID - QID; Cefadroxil 1,000 mg BID
Ceftriaxone**  Cephalexin 500 mg TID - QID (UTI, SSTI); Cefadroxil 1,000 mg BID (UTI, SSTI); Cefuroxime 500 mg BID (UTI, cIAI, Pneumonia)
Ceftazidime*  Same as Ceftriaxone
Cefepime* Same as Ceftriaxone
Vancomycin, Daptomycin Discontinue if no MRSA identified/suspected; Doxycycline 100 mg BID; Sulfamethoxazole/Trimethoprim (dose dependent on indication); Linezolid 600 mg BID
Other Contact ASP Pharmacist for assistance

* If anti-pseudomonal coverage is required, utilize PO levofloxacin

** Oral 3rd generation cephalosporins are not equivalent to ceftriaxone due to poor kinetics and offer no advantages over earlier generation PO options for gram-negative infections

Select the narrowest PO option based on susceptibility. Contact ASP pharmacist for assistance, if needed.