Is your patient ready for IVOST?

1: Clinical improvement in signs of infection 

• e.g. resolving sepsis, reduction in NEWS score, improvement of infection markers e.g. WCC and CRP
• CRP does not usually reflect current severity of illness or the need for IV antibiotics, and may remain elevated as the infection improves. Do not use CRP in isolation to assess whether someone is suitable for IVOST.

2: Oral route is available 

• Safe swallow is present, and tolerating oral route
• No concerns regarding absorption
• Suitable oral alternative available
• For advice on drug administration via enteral tubes, consult ward pharmacist

3: Infection that DOES NOT require prolonged IV therapy

• Examples of infections that usually require prolonged IV therapy include: meningitis, encephalitis, infective endocarditis, bone and joint infections, infected implants or prosthetic devices, Staphylococcus aureus bacteraemia, undrainable abscess.
• For these indications, seek advice from Infectious Diseases / Medical Microbiology for antibiotic ± oral switch plan. 

If all above criteria are met: suitable for IVOST

• Can you STOP antibiotics? e.g. alternative diagnosis, viral infection 
• If not, then SWITCH TO ORAL
  • Are there any positive microbiology results? Select an appropriate narrow-spectrum antibiotic based on relevant culture results and individual patient characteristics (e.g. likely infection, allergy, renal function)
  • Are microbiology results negative (or pending)? Select an empiric oral regimen as per "Suggested empiric oral switch" table.

• Most infections require ≤7 days total (IV + PO) of antibiotics.
• Record the intended duration in the notes, and add a stop date to HEPMA.

If required, advice is available from Infectious Diseases, Medical Microbiology or Pharmacy.