IV to oral switch procedure

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When to consider IV to oral switch
  • Temperature <38oC 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.

Conditions where early IV to oral switch is not appropriate
  • Meningitis and encephalitis
  • Endocarditis
  • Bone and joint infection
  • Confirmed undrained deep abscess
  • Implanted device infection
  • Staphylococcus aureus bacteraemia (SAB)

Summary of IV to oral recommendations for adults

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

5 days

Amoxicillin

AND

Metronidazole   

Co-trimoxazole 

AND  

Metronidazole   

 

Pyelonephritis/Upper Urinary Tract Infection(UUTI)

7 days Co-trimoxazole   Co-amoxiclav is an alternative in patients <75 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 <75 years old with pyelonephritis, or intra-abdominal infection.  With a higher risk of C. difficile infection, where possible, it should be avoided.