IV to oral switch procedure
![](/media/2072/lothian.png)
When to consider IV to oral switch
- Temperature <38oC for >24 hours (evidence of improvement of tachycardia, tachypnoea if present on diagnosis)
- Oral route available (drinking fluids)
- Total duration = IV + oral antibiotic
Do not use gentamicin for >72 hours without reviewing: What to do after 3 days on gentamicin
Where resistance to first line/alternative options is detected use an option on the microbiology report.
Where possible avoid 4C antibiotics (co-amoxiclav, ciprofloxacin, cephalosporins, clindamycin) in patients >75 years old or patients with previous C. difficile infection.
See individual guidelines for more detail (links in table below)
COTRIMOXAZOLE contains TRIMETHOPRIM — do not use if an isolate is resistant to TRIMETHOPRIM or the patient has an allergy to any component.
Indication Where no positive microbiology results is available or an isolate is sensitive |
Total duration (IV + oral) | First line oral option | Alternative oral option (MRSA/penicillin allergy) | Comment or further alternative oral options |
|
5 days |
Flucloxacillin | Doxycycline | Clarithromycin |
Severity assessment for diabetic foot infections |
7 days |
Flucloxacillin | Doxycycline | No evidence of osteomyelitis |
5 days |
Amoxicillin | Doxycycline |
If atypical cover needed (CURB 2) and using Amoxicillin add Clarithromycin |
|
CAP CURB 3-5 |
5 days |
Amoxicillin OR Co-amoxiclav AND consider need for ongoing atypical pneumonia cover
|
Doxycycline OR Clarithromycin |
Coamoxiclav is an alternative. Patients >65 years old have a higher risk of C. difficile infection and amoxicillin may be as effective if the patient has rapidly settled within 72 hours. If atypical cover needed add clarithromycin. |
Hospital-acquired Pneumonia |
5 days |
Doxycycline |
|
Co-trimoxazole |
Aspiration Pneumonia (low severity) |
5 days |
Amoxicillin |
Co-trimoxazole OR Doxycycline |
|
Aspiration Pneumonia (high severity) |
5 days |
Amoxicillin AND Metronidazole |
Co-trimoxazole AND Metronidazole |
Doxycycline AND Metronidazole |
7 days | Co-trimoxazole | Co-amoxiclav is an alternative in patients <65 years old with pyelonephritis, or intra-abdominal infection. With a higher risk of C. difficile infection, where possible, it should be avoided. | ||
Intra-abdominal infection (community acquired e.g peritonitis, diverticulitis) Acute cholecystitis and ascending cholangitis (no radiologically confirmed collections/or biliary obstruction) |
|
Co-trimoxazole AND Metronidazole |
Co-amoxiclav is an alternative in patients <65 years old with pyelonephritis, or intra-abdominal infection. With a higher risk of C. difficile infection, where possible, it should be avoided. |