Intravenous Antibiotics-Oral Switch Therapy (IVOST)
Introduction
Early Intravenous-Oral Switch Therapy (IVOST) is a key stewardship measure that can help to improve patient care and reduce costs.
- It involves switching patients from IV antibiotics to oral antibiotics as soon as possible, once they are clinically stable and able to tolerate oral medications.
Benefits
There are a number of benefits of IVOST, including
- Cost savings are achieved through lowering direct acquisition costs, eliminating the need for ancillary supplies, reducing pharmacy and nursing time, and shortening the length of hospital stay.
- Eliminating adverse events associated with IV therapy, such as infection and extravasation.
- Increasing patient comfort and mobility
- Increasing the possibility of earlier discharge
Criteria
Before a patient can be switched to oral antibiotics, specific criteria must be met. These criteria include
- Tolerating orally
- Patient is not nil by mouth.
- Oral absorption is not compromised (e.g. diarrhoea, vomiting, malabsorptive disorder, partial or total removal of the stomach, short bowel syndrome, unconscious, swallowing disorder)
- No specific indication that requiring higher concentration of antibiotic or prolonged course of IV therapy
- Endocarditis
- Central nervous system infections (e.g. meningitis, brain abscess, etc.)
- Staphylococcus aureus bacteriaemia
- Osteomyelitis
- Septic arthritis
- Infected implant or prostheses
- Necrotising soft tissue infection
- Melioidosis (at least 10 to 14 days of IV therapy)
- Deep-seated infection e.g. abscesses/empyema
- Complicated orbital cellulitis (abscess or other complication)
- Signs of clinical improvement
- Afebrile (<38°C for past 48 hours)
- White cell count (WCC) improved or trending towards normal range (4-12 x109 cells/L)
- CRP trending down
- Hemodynamically stable
- No unexplained tachycardia
- No unexplained hypotension
- No tachypnoea
Common Oral Antimicrobial Options
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