INTRAVENOUS TO ORAL SWITCH POLICY: Antibiotics (Antimicrobial)

All patients commenced on intravenous antibiotics MUST be reviewed DAILY by the medical team responsible for the patient. Questions to be answered:

• is the patient responding?
• what is the causative organism and site of infection?
• can therapy be rationalised from broad-spectrum to narrow-spectrum?
• can the patient be switched from intravenous to oral antibiotics?

Expert advice is available from Medical Microbiology and Pharmacy, if required.
NB: For advice on drug administration via enteral tubes consult the ward pharmacist or Medicines Information.

(high tissue concentrations required)

• infective endocarditis
• meningitis
• bone or joint infection (osteomyelitis, septic arthritis)
• deep seated infection or abscess
• infected implant or prosthesis
• severe, necrotising skin and soft-tissue infection
• Staphylococcus aureus bacteraemia
• cavitating pneumonia
• immunosuppression.

• evidence of clinical improvement from infection
• no signs of systemic inflammation (SSI) ie:
  • temp > 38 or < 36°C
  • heart rate > 90 bpm
  • respiratory rate > 20/minute
  • WCC > 12 or < 4
  • acutely altered mental state
  • blood glucose above the normal range without diabetes
• no absorption problems
• oral fluid and food tolerated
• suitable oral alternative available.
  
  

• reduction in infusion-associated complications, e.g. peripheral venous catheter phlebitis, healthcare-acquired infection
• saves both medical and nursing staff time
• improved patient comfort and mobility
• possibility of earlier discharge
• potential reduction in risk of adverse events; errors in preparation are significantly higher with parenteral drugs, compared with oral formulations
• potential to significantly reduce treatment costs.