Using Antimicrobials Wisely
IV to PO Step Down

IV to PO Step Down

Clinical Considerations

The following drugs should be changed to oral (PO) therapy as soon as clinically feasible and if clinically appropriate

The suggested PO adult doses assume normal renal function

  • Able to tolerate oral food or medications (functional GI tract)
  • Clinically stable
  • Afebrile for at least 24 hours
  • WBC count normal or trending to normal
  • The patient is not being treated for endocarditis, CNS infection, bone or joint infection, bacteremia, or abscess
  • The patient does not have febrile neutropenia

Antimicrobial: Suggested IV to PO Conversions

IV Adult Dose PO Adult Dose
Ampicillin 1 g q6h Amoxicillin 500 mg q8h
IV Adult Dose PO Adult Dose
Azithromycin 500 mg q24h Azithromycin 250-500 mg q24h
IV Adult Dose PO Adult Dose
Cefazolin 1 g q8h Cephalexin 500 mg q6h
IV Adult Dose PO Adult Dose
Ceftazidime 1-2 g q8h Ciprofloxacin 500-750 mg q12h
IV Adult Dose PO Adult Dose
Ceftriaxone 1 g q24h Amoxicillin/Clavulanate 875 mg q12h OR Cefuroxime Axetil 500 mg q12h
IV Adult Dose PO Adult Dose
Cefuroxime 750 mg q8h Cefuroxime Axetil 500 mg q12h
IV Adult Dose PO Adult Dose
Ciprofloxacin 400 mg q12h Ciprofloxacin 500-750 mg q12h
IV Adult Dose PO Adult Dose
Clindamycin 300-600 mg q8h Clindamycin 300-450 mg q6h
IV Adult Dose PO Adult Dose
Fluconazole 200 mg daily Fluconazole 200 mg daily
IV Adult Dose PO Adult Dose
Levofloxacin 500-750 mg q24h Levofloxacin 500-750 mg q24h
IV Adult Dose PO Adult Dose
Metronidazole 500 mg q8h Metronidazole 500 mg q8h
IV Adult Dose PO Adult Dose
Piperacillin/Tazobactam q6-8h Amoxicillin/Clavulanate 875 mg q12h (if no Pseudomonas) OR Ciprofloxacin (if Pseudomonas)

Additional Information

December 2021 TBRHSC ASP Pocket Card