4. Switch to oral therapy

In many instances therapy can be switched from IV to oral once the patient has started to improve. Switching to an effective oral therapy reduces the incidence of hospital-acquired bacteraemias, allows earlier discharge, improves patient comfort and mobility and potentially significantly reduces the cost of treatment.

Patients may be considered for oral therapy if:

There is sufficient microbiological information about the pathogen and its sensitivities

Patients are:

• Haemodynamically stable with no signs of fever
  

• Clinically improving
  

• Able to take oral medications, have a functional GI tract with no malabsorption and there is no interactions with other medications
  

• Not suffering from certain high-risk infections (see below)

Patients on intravenous antibiotics should usually be switched to oral therapy after 24-48 hours of IV therapy unless the following contra-indications apply:

• Sepsis
  

• Immunosuppression
  

• Specific instructions to continue from consultant / microbiologist
  

• Nil by mouth / vomiting / unable to swallow
  

• Unconscious
  

• Malabsorption
  

• More than 1 of the following:

  • Temperature >38 C or <36 C
    

  • Tachycardia >90/min
    

  • Tachypnoea >20 breaths/min
    

  • WCC>12 or <4

Specific high-risk infections. These include:

• Infective endocarditis
  

• Prosthesis/implant/graft infections
  

• Liver abscesses
  

• Adequately drained abscesses and empyemas
  

• Osteomyelitis
  

• Septic arthritis
  

• Severe cellulitis
  

• Bronchiectasis

This is not an exhaustive list.

NOTE Penicillin V is usually not suitable for patients switching from IV therapy since its absorption is erratic.