Converting antibiotics from the intravenous (IV) route to the oral (PO) route when possible has been shown to have benefits to both the patient and the health care system
Benefits include increased patient satisfaction, reduced risk of line related complications, reduced length of stay in hospital, reduced nursing administration time, and reduced cost
Patients on IV antibiotics should be routinely assessed within 72 hours of initiation of IV therapy and regularly thereafter for the appropriateness of IV to PO conversion
This assessment should take into account the patient’s clinical status and site of infection
The patient:
is 18 years of age or older AND
is tolerating food, enteral feeds and/or other oral medications AND
is not showing evidence of malabsorption (e.g. diarrhea/vomiting) AND
does not have continuous nasogastric suctioning, gastrectomy, malabsorption syndrome, GI bleed, GI obstruction or ileostomy
The patient:
has documented improved clinical signs and symptoms of infection AND
is hemodynamically stable AND
has been afebrile for at least 48 hours (T less than 38) AND
has a normal or significantly improved (20%) white blood cell count AND
is not being treated for a condition where parenteral therapy is clinically indicated, including but not limited to: endocarditis, CNS infection (such as meningitis, brain abscess), osteomyelitis, Staph aureus bacteremia, undrained or complicated abscess, cystic fibrosis, febrile neutropenia, septic arthritis, prosthetic joint infection AND
doesn’t have a pathogenic isolate showing resistance to the suggested antibiotic
Horizon Health Network Policy & Procedure Manual – 2014. Antimicrobial Route of Administration (IV to PO) Therapeutic Conversion: https://en.horizonnb.ca/media/927863/ivtopoconversioncriteria.pdf
Mansour, S. (2017, Jan 4). IV to PO Conversion. Covenant Health Antimicrobial Stewardship E-Newsletter. Retrieved from http://extcontent.covenanthealth.ca/CHASEIssue13IVto_PO.pdf
Blondel-Hill E, Fryters S. (2012). Bugs & Drugs. Edmonton: Alberta Health Services.
