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IV To PO Poster Version

This document provides guidance on switching patients receiving intravenous (IV) antibiotics to oral antibiotics for certain infections when they are clinically improving. It lists criteria for considering an IV to oral switch, including being afebrile, having a heart rate under 90 beats per minute, respiratory rate under 20 breaths per minute, and white blood cell count between 4-12 x 109 cells/L. It then lists common IV antibiotics used for various infections and possible oral antibiotic options to step down to based on susceptibilities and the patient's ability to take oral medications.

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John Benedict Sta Ana
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135 views1 page

IV To PO Poster Version

This document provides guidance on switching patients receiving intravenous (IV) antibiotics to oral antibiotics for certain infections when they are clinically improving. It lists criteria for considering an IV to oral switch, including being afebrile, having a heart rate under 90 beats per minute, respiratory rate under 20 breaths per minute, and white blood cell count between 4-12 x 109 cells/L. It then lists common IV antibiotics used for various infections and possible oral antibiotic options to step down to based on susceptibilities and the patient's ability to take oral medications.

Uploaded by

John Benedict Sta Ana
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Antibiotics: IV to PO Stepdown

Recent studies support using oral antibiotics to treat many infections. If your
patient is receiving IV antibiotics, consider a switch to oral if:

+
 Patient is clinically improving, with ≥2 of:  An appropriate oral option is available
• Afebrile based on susceptibilities
• HR <90 beats per minute  Able to tolerate oral intake
• RR <20 per minute  No factors affecting oral absorption
• WBC 4 - 12 x 109 cells/L

IV Antibiotic Indication Possible PO Stepdown*

Amoxicillin 500mg PO TID OR


Pneumonia Cefuroxime 500mg PO TID

Amoxicillin-clavulanate 875mg PO BID OR


Biliary
If penicillin allergic:
Ceftriaxone Ciprofloxacin 500mg PO BID + Metronidazole 500 mg PO BID
Amoxicillin 500mg PO TID OR
Urinary Cefixime 400mg PO daily OR
Tract Co-trimoxazole (TMP-SMX) 1 DS tab PO BID OR
Nitrofurantoin 100mg PO BID (cystitis only)
Non-purulent
Cefazolin Cephalexin 500mg – 1000mg PO QID
cellulitis

Amoxicillin-clavulanate 875mg PO BID +/- Ciprofloxacin 750mg PO


Piperacillin – BID for Pseudomonas coverage OR
tazobactam
if penicillin allergic:
OR
Meropenem Ciprofloxacin 500 mg PO BID + Metronidazole 500mg PO BID OR
Ciprofloxacin 500 mg PO BID + Clindamycin 600 mg PO TID
Review reported susceptibilities. Possible oral options include:

MRSA Doxycycline 100mg PO BID OR


Vancomycin
Infection Co-trimoxazole (TMP-SMX) 2 DS tabs PO BID OR
Clindamycin 600mg PO TID
If unable to use above options, consult ID
NOTE: these suggestions assume normal renal and hepatic function and BMI <40, with no antibiotic allergies
* If a pathogen has been identified, ensure organism is susceptible prior to PO stepdown
604-328-5790

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