Guidance for antimicrobial intravenous to oral switch
Unless the infection is one that requires high tissue concentrations or prolonged parenteral therapy (eg meningitis), reassess the need for ongoing intravenous therapy daily. Patients should be switched to oral or enteral therapy once they are clinically stable. Guidance on when to switch from intravenous to oral therapy is provided in Guidance for intravenous to oral switch.
Where ongoing parenteral therapy is indicated, ambulatory parenteral antimicrobial therapy may be considered for selected patients – see Ambulatory antimicrobial therapy.
Antimicrobial stewardship programs with a focus on intravenous to oral switch have demonstrated improved patient care, and reduced length of hospital stay and antimicrobial costs.
It is often appropriate to switch a patient’s therapy from intravenous to oral when all of the following apply [NB1]:
- the patient has a functioning gastrointestinal system
- there is clinical improvement
- fever is resolved or improving
- there is no unexplained haemodynamic instability
- oral intake is tolerated and there are no concerns about malabsorption
- a suitable oral antimicrobial is available with adequate penetration to the site of infection that either:
- has the same or similar spectrum to the intravenous antimicrobial
- is an oral formulation of the same drug
- for children, a suitable paediatric formulation is available.
NB1: Does not apply to infections that require high tissue concentrations or prolonged intravenous therapy (eg meningitis).