Action 5:
Consider IV to oral
switch
The switch from intravenous (IV) to oral antibiotic
therapy is an important part of antimicrobial stewardship
Key points:

oral therapy when appropriate has a number
of benefits

Ensure criteria and procedures for switching
from IV to oral therapy are available
(AMS), and is included in many best practice guidelines
for AMS.1-3 Switching from IV to oral therapy once a
Switching patients from intravenous (IV) to

Review IV antibiotic therapy every 48 hours
patient has shown significant clinical response to
and consider switch to oral therapy in
treatment can improve the quality of patient care,
accordance with guidelines
minimise adverse events associated with IV therapy
such as thrombophlebitis and line infections, and reduce
health care costs.1, 4-5
Despite the effectiveness of this intervention, the perception that IV therapy throughout is more effective than oral
therapy when suitable oral agents are available is unfounded, and remains a barrier to timely conversion to oral
therapy.6
Certain antibiotics with good oral bioavailability have been shown to be as effective as IV therapy. 4, 7 For antibiotics
available in both oral and intravenous forms, and with good oral bioavailability, a switch to oral treatment as soon
as it is clinically safe to do so is relatively simple. For IV antibiotics where there is no obvious oral equivalent,
alternative oral agents with known efficacy can be used.4, 7
Oral therapy is preferred for a number of reasons. It is in the best interests of the patient to be discharged home as
soon as they are clinically stable and able to tolerate oral medication. A longer length of hospital stay is associated
with the risk of a new multi-resistant infection, development of Clostridium difficile infection, and other preventable
adverse events such as infection from the IV line. Other benefits from switching from IV to oral therapy include
reduced morbidity from (now removed) IV lines and increased patient satisfaction. 4, 8
Switching from IV to oral therapy is not appropriate for all patients. IV to oral switch programs need to be
underpinned by clear criteria and procedures for switching, and specify the roles of doctors, nurses and
pharmacists in identifying which patients might be eligible for switching and to prompt the change to oral therapy.
The individual circumstance of each patient should always be considered. As a general rule, IV antibiotics should
be reviewed after 48 hours and in many cases it will be appropriate to switch to oral therapy. 3, 4 Examples of where
it is NOT appropriate to switch to oral therapy after 48 hours include conditions such as bacteraemia, septic
arthritis, osteomyelitis and meningitis.
The Therapeutic Guidelines: Antibiotic9 provide advice on when it is generally safe to change from IV to oral
therapy, and when it is preferable to continue on intravenous therapy. More information about IV to oral switching is
also available in Antimicrobial Stewardship in Australian Hospitals.4
Useful resources
The Antimicrobial Stewardship (AMS) Clinical Care Standard.
The Antimicrobial Stewardship (AMS) Clinical Care Standard aims to ensure that a patient with a
bacterial infection receives optimal treatment with antibiotics. It provides advice to clinicians,
consumers and health services on key components of care related to antibiotic therapy. The AMS
Clinical Care Standard is due for publication late 2014. For more information, visit
www.safetyandquality.gov.au/ccs
References and further reading
1. Dellit T, Owens R, McGowan J, Gerding D, Weinstein R, Burke J, Huskins W, Paterson D, Fishman N,
Carpenter C, Brennan P, Billeter M, Hooten T. Infectious Diseases Society of America (ISDA) and the Society
for Healthcare Epidemiology of America (SHEA) guidelines for developing an institutional program to enhance
antimicrobial stewardship. Clinical Infectious Diseases 2007;44(2):159-177.
2. Gould IM. Minimum antimicrobial stewardship measures. Clinical Microbiology and Infection 2001;7(Suppl
6):22-26.
3. National Health Service. Antimicrobial prescribing: a summary of best practice. Saving Lives: Reducing
Infection, Delivering Clean and Safe Health Care. London: UK Department of Health, 2009.
4. Duguid M, Cruickshank M (editors). Antimicrobial Stewardship in Australian Hospitals. Sydney: Australian
Commission on Safety and Quality in Health Care, 2011.
5. Drew R, White R, MacDougall C, Hermsen E, Owens R, Jr, Society of Infectious Diseases Pharmacists.
Insights from the Society of Infectious Diseases Pharmacists on antimicrobial stewardship guidelines from the
Infectious Diseases Society of America and the Society of Epidemiology of America. Pharmacotherapy 2009;
29(5):593-607.
6. Schouten JA, Hulscher M, Natsch S, Kullber B, van der Meer J, Grol R. Barriers to optimal antibiotic use for
community-acquired pneumonia at hospitals: a qualitative study. Qual Saf Health Care 2007;16:143-149.
7. Owens R. Antimicrobial stewardship: concepts and strategies in the 21st century. Diagnostic Microbiology and
Infectious Diseases 2008;61:110-128.
8. Ramirez JA, Vargas S, Ritter GW, Brier ME, Wright A, Smith S, Newman D, Burke J, Mushtaq M, Huang A.
Early switch from intravenous to oral antibiotics and hospital discharge. Arch Intern Med 1999:159:2449-2454.
9. Antibiotic Expert Group. Therapeutic Guidelines: Antibiotic. Version 14. Melbourne: Therapeutic Guidelines Ltd;
2010. The next edition of Therapeutic Guidelines: Antibiotic (Version 15) will be published in November 2014.
Date of publication: 24 October 2014
This document is intended for use by health professionals. It has been created from information contained in Antimicrobial Stewardship in
Australian Hospitals 2011 and reviewed by clinical experts. Reasonable care has been taken to ensure this information is accurate at the date of
creation. This fact sheet is intended to be used in its original version and can be downloaded from the Australian Commission on Safety and
Quality in Health Care web page www.safetyandquality.gov.au
“No action today, no cure tomorrow” is adopted from the WHO World Health Day 2011
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