Intravenous to oral conversion
Rationale
- Evidence suggests that early conversion from intravenous (IV) to oral antibiotic therapy is effective for a variety of infections, including those involving the urinary and respiratory tracts, and skin and soft tissues.
- This is possible because of the excellent bioavailability of many of the oral antibiotics now available.
- An early conversion from IV to oral antibiotic therapy in selected patients is an effective way of achieving cost savings in hospital (drug costs and nursing/pharmacy labour costs) while maintaining quality patient care.
Criteria for Conversion from IV to Oral Therapy
- The patient has received 48 hours of IV antibiotics, appears to be improving clinically, and has been afebrile for at least 24 hours.
- The patient is able to take medications orally and there is no evidence of malabsorption.
- The patient is not being treated for Staphylococcus aureus bacteremia, endocarditis, or a CNS/bone/joint infection where the available oral options do not achieve concentrations equal to that of appropriate IV antibiotic management.
Examples of IV to Oral Conversion
| IV Drug | Oral Drug |
|---|---|
| Ampicillin 2 g q6h | Amoxicillin 500 mg TID |
| Azithromycin 500 mg q24h | Azithromycin 500 mg daily |
| Cefazolin 1 g q8h | Cephalexin 500 mg QID |
| Ciprofloxacin 400 mg q12h | Ciprofloxacin 500 mg BID |
| Ciprofloxacin 400mg q8h | Ciprofloxacin 750 mg BID |
| Clindamycin 600 mg q8h | Clindamycin 300 - 450 mg QID |
| Co-trimoxazole 160/800 mg q12h | Co-trimoxazole 1 DS BID |
| Fluconazole 400 mg q24h | Fluconazole 400 mg daily |
| Levofloxacin 750 mg q24h | Levofloxacin 750 mg daily |
| Linezolid 600 mg q12h | Linezolid 600 mg BID |
| Metronidazole 500 mg q12h | Metronidazole 500 mg q12h |
| Voriconazole 200 mg q12h | Voriconazole 200 mg BID |
Last updated: April 18, 2018
