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 treaetment.

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

Clarithromycin

Co-amoxiclav

Flucloxacillin

Benzylpenicillin

Metronidazole

Ciprofloxacin 400mg bd

Ciprofloxacin 400mg tds

Levofloxacin

Clindamycin

Piperacillin/Tazobactam or Meropenem

 

Amoxicillin+Gentamicin+Metronidazole

Vancomycin+Gentamicin+Metronidazole 

 

Amoxicillin 500mg – 1g TDS

Clarithromycin 500mg BD

Co-amoxiclav 625mg TDS

Flucloxacillin 500mg-1g QDS

Amoxicillin 500mg - 1g TDS

Metronidazole 400mg TDS

Ciprofloxacin 500mg BD

Ciprofloxacin 750mg BD

Levofloxacin 500mg BD

Clindamycin 300mg-450mg QDS

d/w microbiology

 

Co-amoxiclav 625mg 8 hourly

Co-trimoxazole 960mg 12 hourly AND Metronidazole 400mg PO 8 hourly

 

Remember CIPROFLOXACIN, METRONIDAZOLE, CLINDAMYCIN and CLARITHROMYCIN have excellent oral bioavailability so oral is as effective as IV

 

Potential benefits from IV switch

  1. Earlier mobilisation and potential discharge of patient
  2. Reduced risk of infection from vascular access devices (e.g. thrombophlebitis, Staph auerus bacteraemia)
  3. Reduction in non-infectious adverse events associated with IV access (e.g. extravasation, pain)
  4. Freeing up of nursing time to manage other aspects of patient care
  5. Improved use of resources