Guidelines
Therapeutic Interchange Program

Therapeutic Interchange Program

Note

The following interchanges have been approved by the Pharmacy & Therapeutics Committee and the Medical Advisory Committee

Dosing assumes normal renal function

Antimicrobial Interchange

All orders except eye drops

Prescribed as Will be Changed to
Amphotericin B, Liposomal (Ambisome™) Amphotericin B, Lipid Complex (Abelcet™)

Prescribed as Will be Changed to
Ampicillin oral q6h Amoxicillin oral q8h

Prescribed as Will be Changed to
Cefazolin 1 g IM/IV q6h Cefazolin 1 g IM/IV q8h

All orders except Paediatrics, NICU & patients with cirrhosis/liver failure

Prescribed as Will be Changed to
Cefotaxime Ceftriaxone 1 g IV q24h (unless Infectious Diseases consult)

Adult only

Prescribed as Will be Changed to
Cefprozil 500 mg po q12h Cefuroxime Axetil 500 mg po q12h

Paediatric only

Prescribed as Will be Changed to
Cefuroxime Axetil (Ceftin™) Cefprozil 15 mg/kg bid (max: 500 mg/dose)

Prescribed as Will be Changed to
Cefuroxime 1 g IV q8h Cefuroxime 750 mg IV q8h

Prescribed as Will be Changed to
Ciprofloxacin 500 mg IV Ciprofloxacin 400 mg IV

All orders except L&D, 1C Maternal Newborn, or if being used as prokinetic

Prescribed as Will be Changed to
Erythromycin 500-1000 mg IV q6-8h Azithromycin 500 mg IV daily x 1; then 250 mg po daily x 4 (if NPO, then stay with IV dose)

Prescribed as Will be Changed to
Levofloxacin 500-750 mg IV daily Levofloxacin 500-750 mg IV x 1; then 500-750 mg PO daily (if NPO, then stay with IV dose)

All orders except Infectious Diseases, Oncology, Gastroenterology or Pharmacy (ASP)

Prescribed as Will be Changed to
Moxifloxacin 400 mg PO daily Levofloxacin 500 mg PO daily (or 750 mg PO daily for pseudomonas)
Moxifloxacin 400 mg IV daily Levofloxacin 500-750 mg IV x 1; then 500-750 mg PO daily (if NPO, then stay with IV dose)

Prescribed as Will be Changed to
Zanamivir 2 puffs BID x 5 days Oseltamivir 75 mg PO BID x 5 days

Additional Information

December 2021 TBRHSC ASP Pocket Card