Do not prefer intravenous antibiotic formulations over oral ones if, after 48 hours of therapy, the patient (both pediatric and adult) meets the criteria for IV-to-oral switch, namely: afebrile, able to take oral medication, showing clinical improvement, and not affected by deep bacterial infections at high risk. (Green recommendation)

Oct 17, 2018

Do not prefer intravenous antibiotic formulations over oral ones if, after 48 hours of therapy, the patient (both pediatric and adult) meets the criteria for IV-to-oral switch, namely: afebrile, able to take oral medication, showing clinical improvement, and not affected by deep bacterial infections at high risk. (Green recommendation)

Type of practice

Drugs

Age

Adult, Geriatric, Pediatric

Topic Area

Clinical Pharmacy and Therapy

Numerous scientific studies have shown, and several guidelines (NICE, WHO) recommend, that intravenous antibiotic therapy should be promptly switched to oral therapy once the IV-to-oral (IV-PO) switch criteria are met—or discontinued if no longer necessary. The criteria are as follows: A – Afebrile, B – Able to take oral medications, C – Clinically improving, D – Not affected by certain deep-seated or high-risk infections (e.g., osteomyelitis, endocarditis, meningitis, empyema, soft tissue infections, septic arthritis, sepsis, abscesses).
Unnecessary continuation of intravenous therapy increases the risk of infection and adverse events, requires more healthcare resources, may prolong hospital stays, and has a greater environmental impact.

 

Sources

1. Waagsbo B, Sundoy A & Paulsen E. Reduction of unnecessary IV antibiotic days using general criteria for antibiotic switch Scand J Infectious Dis 2008; 40: 468-473. doi: 10.1080/00365540701837134.
2. Gasparetto J, Tuon FF, Dos Santos Oliveira D, et al. Intravenous-to-oral antibiotic switch therapy: a cross-sectional study in critical care units. BMC Infect Dis 2019;19:650. doi: 10.1186/s12879-019-4280-0.
3. Sze W T, Kong M C. Impact of printed antimicrobial stewardship recommendations on early intravenous to oral antibiotics switch practice in district hospitals. Pharm Pract (Granada) 2018;16:855. doi: 10.18549/PharmPract.2018.02.855.
4. Mertz D, Koller M, Haller P et al. Outcomes of early switching from intravenous to oral antibiotics on medical wards J Antimicrob Chemother 2009; 64: 188-199. doi: 10.1093/jac/dkp131.
5. Schuts EC, Hulscher M, Mouton JW, et al. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. The Lancet Infectious Diseases 2016;16:847-856. doi: 10.1016/S1473-3099(16)00065-7.

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Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.