IV/PO Switch Flashcards
Meningococcal bacteraemia duration of therapy
4 -5 days
Meningococcal bacteraemia PO switch option?
No
Pneumococcal bacteraemia duration of therapy
7 - 10 days
PO switch in Pneumococcal bacteraemia
Occult (no fever at 24 hours) - only oral antibiotics
Occult (fever at 24 hours) - switch after 24 hours once afebrile and improved
Non-occult (septic) - no oral switch, only IV
Gram negative bacteremia duration of therapy
10 days (7 days for Salmonella non-typhi, 14 days for pseudomonas in HSCT)
PO switch for gram negative bacteraemia?
None, only IV
Staphylococcus aureus bacteraemia duration
7-14 days (MSSA 7 days, MRSA 14 days)
Staphylococcus aureus bacteraemia PO switch
None, only IV
Central venous catheter (CVC) associated
bacteraemia duration
7 days (if CONS in neonate, CVC removal if blood cultures positive after 72 hours of appropriate antibiotics). If line removed, and culture negative, 3 - 7 days
Bacterial endocarditis duration
4-6 weeks depending on organism
Viridans strep bacterial endocarditis
Viridans MIC <0.12 = 2 - 4 weeks
Viridans MIC >0.12 = 4- 6 weeks
S Aureus bacterial endocarditis
MSSA uncomplicated: 4 weeks
MSSA complicated or MRSA: 6 weeks
Bacterial meningitis oral switch
None, only IV
N. meningitidis meningitis
5 - 7 days
H. influenzae meningitis
7 - 10 days
S. pneumoniae meningitis
10 - 14 days
GBS meningitis
14 - 21 days
Gram negative bacilli meningitis
21 days
Listeria meningitis
21 days
Brain abscess/subdural empyema duration
6 weeks duration
Brain abscess PO switch
after 2 - 4 weeks IV if improving
VP shunt infection duration
Uncomplicated: 10 days
Complicated: 21 days (multi-compartmental hydrocephalus,
ventriculitis, multiple organisms, severe peritonitis or
remaining prosthetic material)
VP shunt infection PO switch
None
Streptococcal pharyngitis duration
10 days (Penicillin), no need for IV
Peritonsillar Abscess duration
10 days (1 -2 days IV following drainage)
Otitis Media duration
5 days, up to 10 days if severe. Withhold antibiotics for 48 hours, less if <6 months.
Retropharyngeal abscess duration
10 - 14 days (3- 5 days IV minimum)
Mastoiditis duration
12 - 15 days (5 days IV)
Acute bacterial
sinusitis
7 days after improvement in symptoms, all PO unless unwell/septic
Acute cervical
lymphadenitis
5 - 7 days, IV for 2-3 days if rapidly spreading
Community
acquired
pneumonia
No need for IV unless systemically unwell. 3 days mild, <7 days if moderate/severe and uncomplicated.
If severe/uncomplicated, give IV initially (Severe/complicated: O2 sats<85%, shock receiving IV
bolus, immunocompromise, chronic lung/heart disease)
Ventilator
associated
pneumonia
Good clinical response: 7 days
Non-fermentative Gram-negative bacilli
in sputum: 10 days
Pleural
empyema
7 days, IV to PO switch once drain removed and afebrile for 1 - 2 days
Lung abscess
4 - 6 weeks, IV to PO switch once clinically improving. Abscess >6cm: continue until resolved or cavity small and
stable size
Acute osteomyelitis
3 -4 weeks, IV for 3 -4 days if uncomplicated. If complicated (delayed presentation,
associated wound or abscess): longer
duration IV is likely to be required)
Subacute or
chronic
osteomyelitis
If prosthetic material, needs IV initially. If not, then could just do PO. No consensus on duration
Septic arthritis
2 -3 weeks total duration, 2 -4 days IV then PO
Cellulitis
5 - 7 days. Mild can be all PO, Moderate to Severe need 1-3 days IV then PO switch once improving
Mod/Severe = rapidly spreading erythema, tender,
lymphangitis, systemic features
Preseptal
(periorbital)
cellulitis
7 - 10 days total, 2 - 3 days IV initially then PO once getting better
Orbital Cellulitis
7 - 10 days, 3 -4 days IV, PO switch once improving. Intra-orbital abscesses should be drained, with non
operative management in selected patients
Skin abscesses
0 days if drained.
Superficial surgical site infection
5 - 7 days oral antibiotics if started
Deep surgical
site infection
No minimum recommendation, duration
dependent on clinical improvement. If prosthetic material present, very prolonged antibiotics may be necessary (4 - 6 weeks of IV)
Appendicitis –
uncomplicated
Single pre-op dose, nil needed after surgery
Appendicitis –
complicated,
intra-abdominal
infection
3-7 days total, initial IV. PO once improving and bowel function back
Acute
cholangitis
No clear recommendation around duration or IV/PO switch
Pancreatitis
The only evidence for antibiotic use in pancreatitis in
children is for treatment of established infection
If complications of bacteraemia or pneumonia occu
Necrotising
enterocolitis
7-10 days with further
duration if lack of clinical improvement. All intravenous
UTI
3 -4 days, all PO unless <3 months who should initially get IV
Pyelonephritis
7 - 10 days (7 days if improving. PO generally, IV only if <3 months or not tolerating PO
Epididymitis
Negative urinalysis: no antibiotic
Positive urinalysis: oral antibiotic
for 2 weeks
