Antimicrobial stewardship and IV-to-oral switch — Rapid

Synopsis

Review antimicrobial prescriptions as active clinical decisions, switching safely from intravenous to oral treatment when physiology, absorption, source, pathogen and available oral exposure all support the change.

Every antimicrobial needs an indication, agent, dose, route, start time, review time and intended duration or stop criterion visible in the record.
Review at 48 to 72 hours using diagnosis, cultures, source control, physiology and toxicity: stop, narrow, switch, continue with an end date or revise the diagnosis.
IV-to-oral switch requires clinical improvement, stable haemodynamics, functioning gastrointestinal absorption and an oral option that achieves adequate exposure at the infected site.

Key red flags

Unsafe switch

Shock, escalating oxygen, persistent bacteraemia, vomiting, ileus, malabsorption or a high-risk deep focus argues against routine oral conversion.

Investigation priorities

Clinical trajectory and observationsFirst step

Establish whether infection and organ dysfunction are genuinely improving.

Management branches

48-to-72-hour reviewMake one explicit stewardship decision

Empirical antimicrobial therapy has continued long enough for early response and microbiology to become available.

Reconfirm diagnosis and source, assess physiology and toxicity, review cultures, imaging, procedures and all administered doses.
Choose stop, narrow, IV-to-oral switch, continued IV with indication, or broaden only for a new supported hypothesis; document rationale.

Key medicines

Amoxicillin oralA common adult dose is 500 mg orally three times daily; severe indications may require higher guideline doses.

Doxycycline oralCommon adult treatment is 200 mg on day one then 100 mg once daily, with regimen varying by indication.

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