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Antimicrobial Route of Administration (IV To PO) Therapeutic Conversion

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This document provides criteria for converting patients from intravenous (IV) to oral (PO) antimicrobial therapy within 72 hours of starting IV treatment. It lists general criteria that patients must meet, such as tolerating oral medications and not having issues like diarrhea. It also provides antimicrobial-specific criteria like being clinically improved and hemodynamically stable. Table 1 outlines conversion protocols for targeted antimicrobials, listing IV and oral doses. Table 2 provides adjusted dosing for patients with renal impairment.

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Antimicrobial Route of Administration (IV To PO) Therapeutic Conversion

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doodrill
28 views1 page
This document provides criteria for converting patients from intravenous (IV) to oral (PO) antimicrobial therapy within 72 hours of starting IV treatment. It lists general criteria that patients must meet, such as tolerating oral medications and not having issues like diarrhea. It also provides antimicrobial-specific criteria like being clinically improved and hemodynamically stable. Table 1 outlines conversion protocols for targeted antimicrobials, listing IV and oral doses. Table 2 provides adjusted dosing for patients with renal impairment.

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This document provides criteria for converting patients from intravenous (IV) to oral (PO) antimicrobial therapy within 72 hours of starting IV treatment. It lists general criteria that patients must meet, such as tolerating oral medications and not having issues like diarrhea. It also provides antimicrobial-specific criteria like being clinically improved and hemodynamically stable. Table 1 outlines conversion protocols for targeted antimicrobials, listing IV and oral doses. Table 2 provides adjusted dosing for patients with renal impairment.

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28 views1 page

Antimicrobial Route of Administration (IV To PO) Therapeutic Conversion

Uploaded by

doodrill
This document provides criteria for converting patients from intravenous (IV) to oral (PO) antimicrobial therapy within 72 hours of starting IV treatment. It lists general criteria that patients must meet, such as tolerating oral medications and not having issues like diarrhea. It also provides antimicrobial-specific criteria like being clinically improved and hemodynamically stable. Table 1 outlines conversion protocols for targeted antimicrobials, listing IV and oral doses. Table 2 provides adjusted dosing for patients with renal impairment.

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Antimicrobial Route of Administration (IV to PO)

Therapeutic Conversion

Patients on the targeted IV antimicrobials should be assessed within 72 hours of the start of IV therapy and regularly
thereafter for the appropriateness of IV to PO conversion based on the following criteria (see below for list of targeted
antimicrobials and their renal dose adjustments).

GENERAL CRITERIA
The patient:
is tolerating food, enteral feeds and/or other oral medications AND
is not showing evidence of malabsorption (e.g.diarrhea/vomiting) AND
does not have continuous nasogastric suctioning, gastrectomy, malabsorption syndrome, GI obstruction or
ileostomy

ANTIMICROBIAL CRITERIA
The patient:
is clinically improving (which may include documented improved clinical signs and symptoms of
infection, normalizing white blood cell count, etc…) AND
is hemodynamically stable AND
has been afebrile for at least 48 hours (i.e. temperature less than 38°C) AND
is not being treated for a condition where parenteral therapy is clinically indicated, including but not
limited to: endocarditis, CNS infection, osteomyelitis, S. aureus bacteremia, undrained or complicated
abscess, cystic fibrosis, febrile neutropenia AND
doesn’t have a pathogenic isolate showing resistance to the suggested antibiotic

Table 1: Route of Administration (IV to PO)


Conversion Protocol for Targeted Antimicrobials
Drug IV dose PO drug/dose Interval
azithromycin 250 or 500 mg q24h azithromycin 250 mg q24h
1 1000 mg q8h 1,2
ceFAZolin cephalexin 500 mg q6h
2000 mg q8h
cefTRIAXone 1000 mg q24h 1,2
amoxicillin/clavulanate
(For community-acquired pneumonia q12h
2000 mg q24h 875/125 mg
or acute exacerbation of COPD)
1 400 mg q12h or q24h ciprofloxacin1 500 mg Same as IV
ciprofloxacin
400 mg q8h ciprofloxacin1 750 mg q12h
clindamycin 600-900 mg q8h or q12h clindamycin 450 mg q6h
metroNIDAZOLE1 500 mg q8h or q12h metroNIDAZOLE1 500 mg Same as IV
moxifloxacin 400 mg q24h moxifloxacin 400 mg q24h
levofloxacin1 500-750 mg q24h levofloxacin1 (dose same as IV) Same as IV
1
Dose adjustment required in renal impairment
2
Assess for true penicillin allergy

Table 2: Antimicrobial Dosing in Renal Impairment


Usual adult dose
CrCl 30 - 49
Drug (CrCl equal to or greater CrCl 10 - 29 mL/min CrCl less than 10 mL/min
mL/min
than 50 mL/min)
amoxicillin + clavulanate 875/125 mg q12h no adjustment 500/125 mg q12h 500/125 mg q24h
cephalexin 500 mg q6h 500 mg q8h 500 mg q12h 500 mg q24h
1000 mg q8h no adjustment 1000 mg q12h 1000 mg q24h
ceFAZolin
2000 mg q8h no adjustment 2000 mg q12h 2000 mg q24h
250–500 mg q12h no adjustment extend interval to q24h extend interval to q24h
ciprofloxacin PO
750 mg q12h 500 mg q12h 500 mg q24h 500 mg q24h
400 mg IV q12h no adjustment 400 mg q24h 400 mg q24h
ciprofloxacin IV
400 mg IV q8h 400 mg q12h 400 mg q24h 400 mg q24h
metroNIDAZOLE 500 mg q8h or q12h no adjustment no adjustment 500 mg q12h
CrCl 20-49 mL/min CrCl less than 20 mL/min
750 mg q24h
750 mg q48h 500 mg q48h
levofloxacin
CrCl 20-49 mL/min CrCl less than 20 mL/min
500 mg q24h
250 mg q24h 250 mg q48h
Version: 20160317

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