1. The document discusses automatically converting patients from intravenous (IV) antimicrobial therapy to equivalent oral formulations when possible. This can reduce costs and risks while maintaining treatment effectiveness.
2. The antimicrobial team and pharmacists will assess patients for ability to convert based on criteria like tolerating oral intake and diet. They will change eligible patients to the equivalent oral dose the next day.
3. Examples of antimicrobials with equivalent oral bioavailability are provided, along with sample conversion orders and notes for the medical record. The physician can rescind a conversion but must contact the antimicrobial team.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online from Scribd
1. The document discusses automatically converting patients from intravenous (IV) antimicrobial therapy to equivalent oral formulations when possible. This can reduce costs and risks while maintaining treatment effectiveness.
2. The antimicrobial team and pharmacists will assess patients for ability to convert based on criteria like tolerating oral intake and diet. They will change eligible patients to the equivalent oral dose the next day.
3. Examples of antimicrobials with equivalent oral bioavailability are provided, along with sample conversion orders and notes for the medical record. The physician can rescind a conversion but must contact the antimicrobial team.
1. The document discusses automatically converting patients from intravenous (IV) antimicrobial therapy to equivalent oral formulations when possible. This can reduce costs and risks while maintaining treatment effectiveness.
2. The antimicrobial team and pharmacists will assess patients for ability to convert based on criteria like tolerating oral intake and diet. They will change eligible patients to the equivalent oral dose the next day.
3. Examples of antimicrobials with equivalent oral bioavailability are provided, along with sample conversion orders and notes for the medical record. The physician can rescind a conversion but must contact the antimicrobial team.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online from Scribd
1. The document discusses automatically converting patients from intravenous (IV) antimicrobial therapy to equivalent oral formulations when possible. This can reduce costs and risks while maintaining treatment effectiveness.
2. The antimicrobial team and pharmacists will assess patients for ability to convert based on criteria like tolerating oral intake and diet. They will change eligible patients to the equivalent oral dose the next day.
3. Examples of antimicrobials with equivalent oral bioavailability are provided, along with sample conversion orders and notes for the medical record. The physician can rescind a conversion but must contact the antimicrobial team.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online from Scribd
Download as doc, pdf, or txt
You are on page 1/ 3
1
Automatic IV to PO Conversion of Antimicrobial Agents by The Antimicrobial Team and
Department of Pharmacy Background: Many intravenous agents have equivalent oral preparations. The administration of oral medications relies upon a functioning gastrointestinal tract for adequate absorption of the medication. Early switch from intravenous agents to the equivalent oral preparation offers several benefits: decreased total cost of therapy, decreased potential for line associated infections, a potential for decreased length of stay and patient preference. A key factor in the conversion from IV to PO therapy is the bioavailability of the oral preparation. Bioavailability is expressed as a percentage of the drug concentration of the oral route compared to the IV route in the systemic circulation. An oral agent that is well absorbed is considered equivalent. Additionally, patient specific factors are also important determinants in the decision to switch from IV to PO therapy.
Policy:
I. Antimicrobial Team & the Pharmacy Department
The Antimicrobial Team and/or the Clinical Pharmacists will assess patients ability to convert to oral antimicrobial therapy on the basis of the following criteria:
Table I: Inclusion And Exclusion Criteria
Patient Inclusion Criteria The patient is receiving an oral medication (PO, PEG, NG) that relies upon gastrointestinal absorption for efficacy The patient is receiving an oral diet The patient is receiving tube feeds of at least 50% of their goal rate Patient Exclusion Criteria Patients who are hemodynamic unstable Patients designated NPO for any reason Patients receiving scheduled antiemetics Patients with mucositis and/or receiving chemotherapy that causes mucositis Patients who are being treated for active GI bleed
Table II: Cautions
Drug/Food Interactions with Oral Quinolones and Doxycycline ♦ Certain medications and enteral feeding/dairy products can decrease the absorption of the oral formulation of quinolones and doxycycline ♦ The administration time between oral quinolones/doxycycline and these medications must be separated by two hours ♦ The administration time between oral quinolones/doxycycline and enteral feeding/dairy products must be separated from the dose by two hours pre and two hours post. ♦ Interacting medications include: antacids, iron salts, sucralfate, zinc salts, didanosine and bismuth subsalicylate 2
The Antimicrobial Team and/or the Clinical Pharmacists will convert patients meeting the above criteria from IV to equivalent oral dose and frequency (listed in table III).
The Antimicrobial Team and/or the Clinical Pharmacist will write the conversion order per P&T policy and will be effective the following day (order must include instructions on administration time of the interacting medications/enteral feeding/dairy products if applicable). See appendix A for sample
Table III: Antimicrobials Agents With Equivalent IV to PO Bioavailability
Drug IV normal daily Cost* /day PO normal daily Cost*/day dose (IV) dose (PO) Azithromycin 500 mg Q24H $18 500 mg Q24H $5 Ciprofloxacin 400 mg Q12H $49 500 mg Q12H $6 Doxycycline 100 mg Q12H $10 100 mg Q12H $0.20 Gatifloxacin 400 mg Q24H $18 400 mg Q24H $6 Fluconazole 200-400 mg Q24H $64-$128 200-400 mg Q24H $9-$18 Levofloxacin 500 mg Q24H $28 500 mg Q24H $6 Linezolid 600 mg Q12H $113 600 mg Q12H $84 Metronidazole 500 mg Q8H $5 500mg Q8H $1 Rifampin 600 mg Q24H $61 600mg Q24H $1 Trimethoprim/ 15-20mg /kg/day $27 15-20mg /kg/day $1 Sulfamethoxazole (TMP component) (TMP component) in in 3-4 divided doses 3-4 divided doses * Cost based on acquisition price of drug at University of Maryland Medical Center
A progress note will be written in the chart to indicate the conversion.
See appendix A for sample
The physician must contact the Antimicrobial Team for approval if medical necessity warrants continued IV therapy within this period. If approval is granted, the Antimicrobial Team will notify Pharmacy. Such patient shall be re-evaluated by the Antimicrobial Team/Clinical Pharmacist for oral conversion in 48 hours.
II. Nursing Staffs
Nursing will honor the conversion orders as a medication order and transcribe the orders onto the medication administration records.
3. Medical Staffs Upon review of the automatic conversion order, the Physician may rescind the conversion order, but must contact the Antimicrobial Team for approval to continue the IV therapy. 3
Appendix A Example of Automatic Conversion from IV to Oral Antimicrobials- Progress Notes
Automatic Conversion from IV to Oral Antimicrobials
The Pharmacy and Therapeutics Committee (P&T) has an approved policy for automatic conversion of selected antimicrobials to an equivalent oral dose. Your patient is receiving____________________, which is one of the antimicrobials covered by this policy. By chart review the patient is tolerating an oral diet (or enteral feeding) and/or oral medication. Your patient will be converted to_____________________, effective ________per approved P&T policy. Please contact us if you have any questions (refer to pager below).
Automatic Conversion from IV to Oral Antimicrobial per P&T Policy.
D/C IV______________________ Start:_____________________________________________ Drug Dose Route Frequency First dose to start on: __________________ Date/time ___________________________________________________________ Date Time Signature Beeper number
