Contents

Antimicrobial IV to PO Conversion Protocols

The most current version of the IV to PO Conversion Protocols can be found online at http://www.preceptor.com/other/pharmadm/tipsite/PocketCard.html

Conversion Procedure:

1. Eligible patients will be identified by pharmacy based on the following criteria.
1. Functioning GI tract
2. Currently taking other PO or NG medications
3. Patient is clinically improving
2. The pharmacist will stamp a short note (order) in the Orders section and the Progress section if necessary.  The pharmacist will then enter the oral order into the computer system with start date entered 24 hours into the future.
3. If the physician feels that conversion to oral therapy is appropriate, but would like to use a different medication or dose, then he/she will discontinue the pharmacy initiated conversion order and write the desired order in the order section of the chart.
4. If the physician would not like the conversion to occur, he/she will write an order in the order section saying "NO IV TO PO CONVERSION".  The pharmacist will discontinue the oral order and continue the IV order.  The pharmacist at this time will also place a note in the comments section of the IV medication computer order with the current date and "NO IV TO PO CONVERSION", therefore identifying medications the physician does not want switched to oral.
5. If a physician has not written an order for "NO IV TO PO CONVERSION" within 24 hours, the pharmacist will assume that the recommendation is acceptable and will initiate the oral therapy.

All inpatient units are included in the IV to PO program.

Conversion Protocols

If the patient is on this IV medication...			Convert patient to this PO medication if they meet criteria for conversion...
Drug	Regimen		Drug	Regimen	Bioavailability	Month/Year Initiated
Azithromycin  (Zithromax®)	250 mg IV q24h  500 mg IV q24h		Azithromycin  (Zithromax®)	250 mg PO/NG q24h  500 mg PO/NG q24h	37%	9/2000
Ciprofloxacin  (Cipro®) Schedule doses to begin after HD	200 mg IV q12h  200 mg IV q24h  400 mg IV q12h  400 mg IV q24h		Ciprofloxacin  (Cipro®)	250 mg PO/NG q12h  250 mg PO/NG q24h  500 mg PO/NG q12h  500 mg PO/NG q24h	60-80%	9/2000
Clindamycin  (Cleocin®)	300 mg IV q6h  300 mg IV q8h  600 mg IV q6h  600 mg IV q8h  900 mg IV q6h  900 mg IV q8h		Clindamycin^#  (Cleocin®)	150 mg PO/NG q6h  150 mg PO/NG q8h  300 mg PO/NG q6h  300 mg PO/NG q8h  450 mg PO/NG q6h  450 mg PO/NG q8h	90%	7/2002
Fluconazole  (Diflucan®)	100 mg IV q24h  200 mg IV q24h		Fluconazole  (Diflucan®)	100 mg PO/NG q24h  200 mg PO/NG q24h	90%	9/2000
Linezolid  (Zyvox®)	600 mg IV q12h		Linezolid  (Zyvox®)	600 mg PO/NG q12h	100%	7/2002
Metronidazole  (Flagyl®)	500 mg IV q6h  500 mg IV q8h		Metronidazole  (Flagyl®)	500 mg PO/NG q6h  500 mg PO/NG q8h	100%	9/2000
Moxifloxacin^y  (Avelox®)	400 mg IV q24h		Moxifloxacin^y  (Avelox®)	400 mg PO q24h	90%	7/2002
Rifampin  (Rifadin®)	IV q8-24h		Rifampin  (Rifadin®)	Equivalent rifampin dose  (same dose as IV) q8-24h	90-95%	7/2002
TMP-SMX  (Bactrim®)	IV q6-12h		TMP-SMX  (Bactrim®)	Equivalent TMP dose  PO/NG q6-12h	90-100%	7/2002

^#	Diarrhea at higher oral dose and frequency.
^y	Levofloxacin, gatifloxacin, and trovafloxacin will be subject to the automatic therapeutic interchange program for IV and PO quinolones (unless the prescriber writes "Do Not Substitue").  No dosage adjustment is necessary for renal or hepatic dysfunction.  Check microbiology results for susceptibility data when appropriate.