IV to PO Step-Down

IV to PO Step-Down


  • 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
  • All health care providers can consider IV to PO antimicrobial step-down based on this guidance document.


The following criteria should be met before considering changing to oral therapy:

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

Antimicrobial Step-Down

Additional Information

  • Approved by ASSC and PD&T on Feb 4 2020
  • Review date: 2024