Antibiotics:IVtoOral

BenefitsofEarlySwitchtoOralTherapy

DecreasedriskofcomplicationsfromIVlines:thrombophlebitis,catheterrelated
infections
Morepatientfriendly(improvesmobilityandcomfort)
Mayleadtoearlierdischarge
Savesmedicalandnursingtime
Reductionincosts:
Directmedication
Indirectdiluents,equipment,needles

AMelbournehospitalthatimplementedasimilarcampaignestimatedtheysavednearly
$100,000perannuminmedicationcostsalone,simplybyreducingexcessIVantibiotic
use.

SafetyofSwitching
Alargenumberofclinicaltrialssupportearlyswitchingtooralantibiotics,followingtwo
tothreedaysoftreatmentwithIVtherapy1,2
Equaltreatmentefficacy
Noadverseeffectsonpatientoutcome

CriteriaforSwitching

Oralfluids/foodsaretoleratedandnoreasontobelievethatpoororalabsorption
maybeaprobleme.g.vomiting,diarrhoea
Temperaturelessthan38Cfor24to48hours
Nosignsofsepsis
Anappropriateoralantibioticisavailable
ExtrahightissueantibioticconcentrationsoraprolongedcourseofIVantibiotics
arenotessential

ConditionswhereSWITCHshouldbeconsidered

Gramnegativebacteraemia
Hospitalacquiredinfections
Intraabdominalinfections
Pneumonia
Skinandsofttissueinfections
Urinarytractinfections

BarlowGD,NathwaniD.SequentialAntibioticTherapy.CurrOpinInfectDis.2000;13(6):599607
SevincFetal.EarlySwitchfromIntravenoustoOralAntibiotics:GuidelinesandImplementationina
LargeTeachingHospital.JAntimicrobChemother.1999;43:601606
2

SouthernHealthTherapeuticsCommittee
SouthernHealthPharmacyDepartment
AMPSCommittee

ConditionswhereSWITCHisnotappropriate
ConditionswhichrequireaprolongedcourseofIVantibioticsorveryhightissue
concentrations
Boneandjointinfections
Cysticfibrosis
Endocarditis
Deepseatedabscess
Meningitis
S.aureusbacteraemia

AntimicrobialswithExcellentOralBioavailability
Fluconazole(>90%)
Ciprofloxacin(7080%)
Metronidazole(>95%)

Moxifloxacin(~90%)
Clindamycin(~90%)

SuggestedConversionRegimens
RefertoTherapeuticGuidelines:Antibioticfordosinginspecificindications

IV

Oral

Antimicrobial

UsualDose*

Antimicrobial

UsualDose*

Ampicillin

12gIVQID

Amoxycillin

500mg1goralTDS

Azithromycin

500mgIVDaily

Benzylpenicillin

1.2gIVQID

Ceftriaxone

1gIVDaily

Cephazolin

1gIVTDS

Ciprofloxacin^

200400mgIVBD

Ciprofloxacin^

250500mgoralBD

Flucloxacillin
Lincomycin
Fluconazole^

1gIVQID
600900mgIVTDS
200400mgIVdaily

Flucloxacillin
Clindamycin^
Fluconazole^

500mgoralQID
300600mgoralTDS
200400mgoraldaily

Metronidazole^

500mgIVBD

Metronidazole^

400mgoralTDS

Roxithromycin
300mgoraldaily
Phenoxymethyl
500mgoralQID
penicillin
Nooralformulation
Choiceoforalantibioticdependson
infectionsite/microbiology
Cephalexin
500mgoralQID

*Usualdoseforadultpatientswithnormalrenalfunction.
^
Antimicrobialswithexcellentoralbioavailability

Forfurtherinformationcontact:
Yourwardpharmacist
Infectiousdiseasesregistrar/consultant
Infectiousdiseasespharmacist
Pager4325
Ext41364
SouthernHealthTherapeuticsCommittee
SouthernHealthPharmacyDepartment
AMPSCommittee