IV to Oral Switch Policy

 

Indications for IV Route

1.       Sepsis or severe sepsis

2.       Febrile with neutropenia or immunosuppression

3.       CAP with CURB 65 ≥ 3

4.       Specific indications e.g. endocarditis, meningitis, deep abscesses, bone/joint infections, central line infections

5.       Skin and Soft tissue infections: IV therapy when heat, erythema and induration +/- sepsis

6.       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 considered for a switch to oral WITHIN THE FIRST 48 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 deep seated infection as above)

Generally patients who can:

·         Swallow and tolerate oral fluids

·         Are clinically improving

·         Have been apyrexial for at least 24 hours

·         Have a HR <90 bpm for previous 12 hours

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

IV Agent

Oral Agent

 

Amoxicillin

Clarithromycin

Ceftriaxone or Co-amoxiclav

Flucloxacillin

Benzylpenicillin

Metronidazole

Gentamicin or Ciprofloxacin

Clindamycin

Piperacillin/Tazobactam or Meropenem

 

Amoxicillin 500mg – 1g tds

Clarithromycin 500mg bd

Co-amoxiclav 625mg tds

Flucloxacillin 500mg-1g qds

Amoxicillin 500mg tds

Metronidazole 400mg tds

Ciprofloxacin 500mg bd

Clindamycin 150mg-450mg qds

D/W microbiology

Remember CIPROFLOXACIN and CLINDAMYCIN have excellent oral bioavailability

 

Potential benefits from IV switch

  1. Reduction in S.auerus bacteraemia (SAB) from infected venflon sites
  2. Reduction in adverse events associated with IV therapy
  3. Improved use of resources