What are the benefits of switching from intravenous to oral therapy?

Updated: Jul 30, 2018
  • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Switching from intravenous (IV) to oral (PO) therapy as soon as patients are clinically stable can reduce the length of hospitalization and lower associated costs. While intravenous medications may be more bioavailable and have greater effects, some oral drugs produce serum levels comparable to those of the parenteral form. Medications involved in switch therapy include antibiotics, analgesics, antipsychotics, and antivirals. Pharmacist-facilitated antimicrobial stewardship initiatives can aid to IV to PO switches. [1] Recent studies in 2014 have underscored the cost savings and effectiveness of IV to oral switch therapy. [2, 3]   A 2015 study shows that for low risk variates of Staphylococcus aureus bloodstream infection can be switched from IV to PO rapidly. [4]  Even IV treatment of methicillin-resistant Staphylococcus aureus involving the skin can be shifted to PO therapy in many patients. [5]

Early switching of intravenous to oral antibiotics is possible, and positive outcomes have been reported in medical wards. [6] In addition, a 2008 meta-analysis found that early switching of intravenous to oral antibiotics is possible in moderate to severe community-acquired pneumonia (CAP). [7] In particular, quinolones can be switched effectively and rapidly from intravenous to oral formulations when patients can tolerate medications orally. [8] Many doctors continue to not be aware of guidelines for intravenous to oral switches, their thinking complicated by patients with complex problems. [9] Nevertheless guidelines can help doctors make the proper decision to do the switch in appropriate patients. [10] A useful antibiotic in IV to oral switch is linezolid. [11]

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