Conversion from IV to oral antibiotic therapy should be considered in patients meeting ALL the following criteria:

  • The patient has a diagnosis and, when a pathogen has been identified, antimicrobial susceptibility compatible with oral antibiotic therapy.  Diagnoses that EXCLUDE a switch to PO include: Staphylococcus aureus bacteremia, neutropenic fever, endocarditis, CNS infections (e.g., meningitis), septic shock, and any infection in which source control has not been adequately achieved.
  • The patient’s GI tract is functioning (i.e., tolerating medications via oral or enteral route for ≥24 hours and tolerating food or enteral feeds for ≥24 hours). Exclusions to this criterion include: active NPO order, severe nausea, vomiting, active receipt of anti-emetics, severe diarrhea, mucositis, malabsorption, ileus, receipt of vasopressor therapy, receipt of TPN within 72 hours, and active GI bleed.
  • The patient is hemodynamically stable for ≥24 hours (i.e., heart rate <100 bpm, SBP >99 mm Hg, and respiratory rate <20 bpm).
  • The patient shows clinical improvement (i.e., temperature <100°F or < 37.7°C) for ≥24 hours and WBC count downtrending or normalized.

IV antibiotics that also have excellent bioavailability when given orally are particularly good candidates for IV-to-PO conversion. These antibiotics include:

  • Azithromycin
  • Clindamycin
  • Doxycycline
  • Fluconazole
  • Fluoroquinolones (ciprofloxacin, levofloxacin)
  • Linezolid
  • Metronidazole
  • Trimethoprim-sulfamethoxazole