IV to Oral Switch Policy

Indications for IV Route

1.       Sepsis or severe sepsis

2.       Febrile with neutropenia or immunosuppression

3.       Specific infection indications e.g. Endocarditis, Meningitis, deep abscesses, Staph aureus bacteraemia

4.       Oral route compromised, nil by mouth, reduced absorption, mechanical swallowing disorder, unconscious, no oral formulation available

Definition of Sepsis

Life threatening organ dysfunction caused by a dysregulated host response to a new infection – IV therapy should be commenced immediately and reviewed on a daily basis as patient improves. Severity of illness may be guided by NEWS.

IV to Oral Switch Policy

Patients receiving IV therapy MUST be reviewed for a switch to oral WITHIN THE FIRST 72 HOURS then EVERY 24 HOURS THEREAFTER if the indications listed above are not present and the patient is improving. If IV therapy is still required, de-escalate if possible based on microbiology results.  Reason for continuing IV therapy MUST be documented at reach review unless suspected/confirmed diagnosis advocating prolonged IV treatment.

General features indicating oral antibiotics are appropriate:

• Able to swallow and absorb oral medications
• Clinical response on antibiotic therapy
• Have been apyrexial for at least 24 hours or improvement in fever
• Haemodynamically stable

AND there is an oral formulation or alternative antibiotic available should be switched to oral

 IV Agent/Empirical Regime

Oral Agent

 Amoxicillin 500mg–1g 8 hourly

 Clarithromycin

 Clarithromycin 500mg 12 hourly

 Co-amoxiclav

 Co-amoxiclav 625mg 8 hourly

 Flucloxacillin

 Flucloxacillin 500mg-1g 6 hourly

 Amoxicillin 500mg-1g 8 hourly

 Metronidazole

 Metronidazole 400mg 8 hourly

 Ciprofloxacin 400mg 12 hourly

 Ciprofloxacin 500mg 12 hourly

 Ciprofloxacin 400mg 8 hourly

 Ciprofloxacin 750mg 12 hourly

 Levofloxacin

 Levofloxacin 500mg 12 hourly

 Clindamycin 300mg-450mg 6 hourly

 Piperacillin/Tazobactam (Tazocin)

 Co-amoxiclav 625mg 8 hourly

 (if prior co-amoxiclav use - Co-trimoxazole 960mg 12 hourly

 AND Metronidazole 400mg PO 8 hourly)

 Based on available sensitivity results or d/w microbiology

 Amoxicillin+Gentamicin+Metronidazole

 Co-amoxiclav 625mg 8 hourly

 Vancomycin+Gentamicin+Metronidazole 

 Co-trimoxazole 960mg 12 hourly AND Metronidazole 400mg PO

 8 hourly