Wong-Beringer et al developed a method for switching a patient receiving intravenous antibiotic therapy to the oral route. This can result in a significant cost savings without loss of efficacy, provided guidelines are adhered to. The authors are from the Western University of Health Sciences and the Palo Alto VA Medical Center in California.


Criteria for patient selection:

(1) The patient has been able to tolerate other oral medications.

(2) The patient is able to eat, or tolerate enteral feedings with minimal residuals (< 50% of hourly rate).

(3) The patient is not experiencing nausea or vomiting.

(4) The patient is hemodynamically stable or has shown clinical improvement over 24-48 hours.

(5) The patient does not have meningitis or endocarditis.

Criteria for antibiotic selection:

(1) Continued antibiotic therapy is indicated to treat an underlying infection. (If not, recommend discontinuation of antibiotic therapy).

(2) The organism or probable organism is susceptible to the antibiotic. (If not, then select a different antibiotic).

(3) The oral formulation and dosage selected have adequate pharmacodynamic characteristics, with high oral bioavailability.

(4) The antibiotic should show a significantly lower cost when given by the oral route as compared to intravenous administration.


In the Appendix, the authors list the steps for implementing a route conversion program (page 1149).


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