Wellington ICU Drug Manual: Appendices

appendix 8:
Intravenous to oral antibiotic conversion

Wellington ICU Drug Manual - Intravenous to Oral Antibiotic Conversion

There are multiple benefits to changing from intravenous to oral antibiotics when it is safe to do so. These include:

  • decreased infection risk from intravenous lines
  • decreased risk of thrombophlebitis
  • decreased patient discomfort
  • savings in cost of disposables
  • savings in nursing time

Please consult the unit pharmacist or ICU specialist if you are unsure. Before converting from intravenous to oral antibiotics, all of the following SWITCH criteria should be met.

SWITCH Criteria

Suitable oral alternative available
When patient afebrile >24 hours
Infectious condition suitable for oral treatment1
Tolerating oral/nasogastric food or fluid
Clinical & laboratory trend towards improvement2
Haematology/Oncology patients excluded

1 Infections that are unsuitable for SWITCH include bone/joint/CNS infection, bacterial endocarditis, cystic fibrosis/bronchiectasis, undrained abscesses, infected prosthesis, and Staphylococcus aureus bacteraemia
2 WBC 4- 1 1 or improving, vital signs normal or normalising

Intravenous antibiotics with oral options

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Information from CCHV Infectious Diseases Service 2019