Bone and joint infections | Peritonitis |
Spreading cellulitis | Osteomyelitis |
Lymphadenopathy and high fever | Septicaemia |
Endocarditis | Septic arthritis |
Encephalitis | Severe pneumonia |
Febrile neutropenia | Staphylococcal bacteraemia |
Infective gangrene | Meningitis |
Please note some agents such as Clindamycin and Linezolid are well absorbed orally and substantially cheaper. There is little benefit to using them IV where oral route can be used.
COMMIT (Community / home intravenous antibiotic therapy) service is offered from South Shore primary care centre IV clinic (Ext 1223) to ‘medically stable adult patients with any infectious condition’ requiring intravenous antibiotics. Suitable patients may be e-referred to COMMIT (from links on intranet page) after discussion with the microbiologists or ID physician See intranet link
Intravenous antimicrobial therapy must be reviewed at 48 hours and switched to oral alternatives when clinically appropriate.
Unnecessarily prolonged intravenous therapy is associated with an increased risk of superinfection, extravasation and thrombophlebitis, and has been shown to delay discharge from hospital. Switch to oral antimicrobial therapy should be considered for patients who meet the criteria outlined in the Change to ORAL Antibiotics Guideline (CHORAL).
To provide guidance for the rational conversion of patients from parenteral antibiotic therapy to oral after 48 hours wherever possible.
Rationale
To reduce the risk of complications associated with parenteral antibiotic use:
Guideline
For most infections and most patients, intravenous antibiotic therapy can be converted to oral 24-48 hours after the start of treatment, as long as the following criteria are met:
Patients presenting with any of the following should NOT be converted to oral antibiotics without discussing with responsible consultant / Microbiologist during working hours:
Bone and joint infections | Peritonitis |
Spreading cellulitis | Osteomyelitis |
Lymphadenopathy and high fever | Septicaemia |
Endocarditis | Septic arthritis |
Encephalitis | Severe pneumonia |
Febrile neutropenia | Staphylococcal bacteraemia |
Infective gangrene | Meningitis |
N.B. in ALL these cases targeted/planned duration of parenteral antibiotics should be used.
THINK COMMIT: Intravenous antibiotics for medically stable adult patients with any infectious condition requiring IV antibiotics is available from South Shore primary care centre based IV clinic or home administration. Please contact consultant microbiologists or ID physician to discuss and refer suitable patients.
This list is NOT exhaustive, but shows the step down oral therapy for commonly prescribed intravenous antibiotics. Where a dose range is stated, the dose should be selected based on the severity and site of infection.
Intravenous antibiotic |
Oral antibiotic and dose |
Amoxicillin |
Amoxicillin 500mg – 1g 8 hourly |
Benzylpenicillin |
Phenoxymethylpenicillin 500mg 6 hourly |
Cephalexin 500mg 8 hourly |
|
Cephalosporin (LRTI) |
Cefixime 200mg 12 hourly |
Clindamycin |
Clindamycin 600mg 6 hourly |
Clarithromycin |
Clarithromycin 500mg 12 hourly |
Ertapenem |
Discuss with Microbiologist during working hours |
Flucloxacillin |
Flucloxacillin 500mg-1g 6 hourly |
Gentamicin |
Discuss with Microbiologist during working hours |
Metronidazole |
Metronidazole 400mg 8 hourly |
Meropenem |
Discuss with Microbiologist during working hours |
Piperacillin-tazobactam |
Co-amoxiclav 625mg 8 hourly |
Teicoplanin |
Discuss with Microbiologist during working hours |
Vancomycin |
Discuss with Microbiologist during working hours |