IV to oral switch Guideline

N.b. Excludes severely immunocompromised patients such as chemotherapy-related neutropenia and/or bone marrow transplant.

  • The majority of patients with a severe infection who are adequately absorbing oral medication and initially require IV therapy can be safely switched to oral therapy within 48 hrs
  • For considerations for early switch to oral therapy see “COMS”. Patients should generally have all of the COMS criteria
  • Review at 24-48 hours after starting IVs and then at least every 48 hours
C Clinical improvement observed
O

Oral route is not compromised by vomiting, malabsorptive disorder, nil by mouth, swallowing problems, unconscious, severe diarrhoea. Suitable oral antibiotic option available. NB: if NG/PEG feeding consult pharmacy

M

Markers showing trend towards normal:

  • Apyrexial for the last 24hrs
  • Temp >36°C and <38°C AND no more than one of the following:
  1. CRP >100mg/L
  2. Heart rate >90/min
  3. Respiratory rate >20/min
  4. BP unstable
  5. WCC <4 or >12x109/L. White cell count should show a trend towards normal; absence of such should not impede oral switch if all other criteria are met and not neutropenic
S No Specific indication/deep seated infection requiring prolonged iv therapy where oral switch is inappropriate including: Endocarditis, Meningitis, Bone/Joint infections.