INTRAVENOUS TO ORAL SWITCH POLICY: Antibiotics (Antimicrobial)


The Management of Infection Guidance provides advice on when the intravenous route is appropriate.

For glossary of terms see Glossary

Frequent review

All patients commenced on intravenous antibiotics MUST be reviewed DAILY by the medical team responsible for the patient. Questions to be answered:

  • is the patient responding?
  • what is the causative organism and site of infection?
  • can therapy be rationalised from broad-spectrum to narrow-spectrum?
  • can the patient be switched from intravenous to oral antibiotics?

Expert advice is available from Medical Microbiology and Pharmacy, if required.
NB: For advice on drug administration via enteral tubes consult the ward pharmacist or Medicines Information.

Exclusions from intravenous to oral switch

(high tissue concentrations required)

  • infective endocarditis
  • meningitis
  • bone or joint infection (osteomyelitis, septic arthritis)
  • deep seated infection or abscess
  • infected implant or prosthesis
  • severe, necrotising skin and soft-tissue infection
  • Staphylococcus aureus bacteraemia
  • cavitating pneumonia
  • immunosuppression.

Suggested criteria to be met before intravenous to oral switch

  • evidence of clinical improvement from infection
  • no signs of systemic inflammation (SSI) ie:
    • temp > 38 or < 36°C
    • heart rate > 90 bpm
    • respiratory rate > 20/minute
    • WCC > 12 or < 4
    • acutely altered mental state
    • blood glucose above the normal range without diabetes
  • no absorption problems
  • oral fluid and food tolerated
  • suitable oral alternative available.

Advantages of intravenous to oral switch

  • reduction in infusion-associated complications, e.g. peripheral venous catheter phlebitis, healthcare-acquired infection
  • saves both medical and nursing staff time
  • improved patient comfort and mobility
  • possibility of earlier discharge
  • potential reduction in risk of adverse events; errors in preparation are significantly higher with parenteral drugs, compared with oral formulations
  • potential to significantly reduce treatment costs.

Last reviewed: 20/09/2022

Next review date: 31/05/2025

Author(s): Antimicrobial Management Team.

Version: 7

Approved By: Formulary Subgroup

Reviewer name(s): Alison Macdonald, Area Antimicrobial Pharmacist.

Document Id: AMT135

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