IV to oral switch procedure

When to consider IV to oral switch

Temperature <38^oC for >24 hours (evidence of improvement of tachycardia, tachypnoea if present on diagnosis)
Oral route available (drinking fluids)
Total duration = IV + oral antibiotic

Do not use gentamicin for >72 hours without reviewing: What to do after 3 days on gentamicin

Where resistance to first line/alternative options is detected use an option on the microbiology report.

Where possible avoid 4C antibiotics (co-amoxiclav, ciprofloxacin, cephalosporins, clindamycin) in patients >75 years old or patients with previous C. difficile infection.

See individual guidelines for more detail (links in table below)

COTRIMOXAZOLE contains TRIMETHOPRIM — do not use if an isolate is resistant to TRIMETHOPRIM or the patient has an allergy to any component.

Indication Where no positive microbiology results is available or an isolate is sensitive	Total duration (IV + oral)	First line oral option	Alternative oral option (MRSA/penicillin allergy)	Comment or further alternative oral options
Cellulitis	5 days	Flucloxacillin	Doxycycline	Clarithromycin
Severity assessment for diabetic foot infections	7 days	Flucloxacillin	Doxycycline	No evidence of osteomyelitis
CAP CURB 0-1 CAP CURB 2	5 days	Amoxicillin	Doxycycline	If atypical cover needed (CURB 2) and using Amoxicillin add Clarithromycin
CAP CURB 3-5	5 days	Amoxicillin OR Co-amoxiclav AND consider need for ongoing atypical pneumonia cover	Doxycycline OR Clarithromycin	Coamoxiclav is an alternative. Patients >65 years old have a higher risk of C. difficile infection and amoxicillin may be as effective if the patient has rapidly settled within 72 hours. If atypical cover needed add clarithromycin.
Hospital-acquired Pneumonia	5 days	Doxycycline		Co-trimoxazole
Aspiration Pneumonia (low severity)	5 days	Amoxicillin	Co-trimoxazole OR Doxycycline
Aspiration Pneumonia (high severity)	5 days	Amoxicillin AND Metronidazole	Co-trimoxazole AND Metronidazole	Doxycycline AND Metronidazole
Pyelonephritis/Upper Urinary Tract Infection(UTI)	7 days	Co-trimoxazole		Co-amoxiclav is an alternative in patients <65 years old with pyelonephritis, or intra-abdominal infection. With a higher risk of C. difficile infection, where possible, it should be avoided.
Intra-abdominal infection (community acquired e.g peritonitis, diverticulitis) Acute cholecystitis and ascending cholangitis (no radiologically confirmed collections/or biliary obstruction)		Co-trimoxazole AND Metronidazole		Co-amoxiclav is an alternative in patients <65 years old with pyelonephritis, or intra-abdominal infection. With a higher risk of C. difficile infection, where possible, it should be avoided.