IV to PO Antibiotic Guideline

IV to PO Antibiotic Guideline

Key Points

Many oral antimicrobials have excellent bioavailability and conversion from IV to PO antimicrobial therapy in selected patients is an effective way of achieving the following:

  • Shortened length of hospital stay
  • Reduced risk of line-related infections and adverse events such as thrombophlebitis and catheter-related bloodstream infections
  • Increase patient mobility
  • Cost savings through medication preparation/administration, IV supplies, and drug costs

The switch or step-down to oral therapy must be individualized based upon the patient’s clinical status and infection

With appropriate IV to PO conversion, there is no difference in treatment success or mortality

Early Switch to Oral Therapy

  • Clinical improvement observed
  • Oral route is not compromised (vomiting, malabsorption, swallowing difficulties, unconscious, severe diarrhea) and a suitable oral antibiotic (with good bioavailability) option is available
  • The patient does not fall under the parameters of exclusion

Patients should NOT be converted to oral therapy if they meet any of the following exclusion criteria

  • Hemodynamic instability
  • Active GI bleed
  • Disease states associated with malabsorption (e.g. active Inflammatory Bowel Disease, short gut syndrome, continuous enteral feeds that impair absorption of oral fluoroquinolones)
  • Removal of part of GI tract, ileus or GI obstruction
  • Difficulty swallowing
  • Severe diarrhea/nausea/vomiting
  • Pancreatitis
  • Drug interactions that would limit oral antimicrobial absorption

Patients should NOT be converted to oral therapy if they meet any of the following exclusion criteria, unless switch advised by infectious disease physican

  • Endocarditis
  • S. aureus bacteremia
  • CNS infection (e.g. meningitis, encephalitis, intracranial abscess)
  • Necrotizing fasciitis or other severe soft tissue infection
  • Vascular graft infections