Intravenous to oral conversion (IV to PO) involves a policy or guideline for switching the route of administration after careful patient assessment. This switch over from intravenous to oral therapy is widely practiced in the case of antibiotics in many countries
Objective of this exercise is to train you on the following,
1. To make you understand about IV To PO and its advantages and disadvantages.
2. To understand the types of IV to Oral Conversion
3. To learn the Practical approaches for conversion of a patient from IV to oral therapy
4. To understand which patient and drugs are eligible for IV for PO conversion
Advantages and Disadvantages of IV to PO
• Improved patient comfort and mobility
• Reduced exposure to nosocomial pathogens through the IV site
• Decreased risk of phlebitis
• Reduced preparation and administration time
• Lower costs (drug cost, IV tubing, syringes, IV pumps)
• Decreased length of stay
• Could encourage unnecessarily prolonged courses of a treatment
• May encounter physician or nurse reluctance/reservations even if criteria are met.
Types of IV to oral conversions:
Sequential therapy: It refers to the act of replacing a parenteral version of a medication with its oral counterpart of the same compound. For instance, conversion of inj. pantoprazole 40 mg OD (once daily) to tab. pantoprazole 40 mg OD
Switch therapy: It describes the conversion of an IV medication to a PO equivalent; within the same class and has the same level of potency, but of a different compound. For example, switch over from inj. ceftriaxone 1 g BD to tab. cefixime 200 mg BD, switch over from inj. pantoprazole 40 mg BD to tab. rabeprazole 20 mg BD
Step down therapy: It refers to the conversion from an injectable medication to an oral agent in another class or to a different medication within the same class where the frequency, dose, and the spectrum of activity (in the case of antibiotics) may not be exactly the same. For example, conversion of inj. cefotaxim 1 g to tab. ciprofloxacin 500 mg, switch over from inj. heparin to tab. warfarin.
It is the sole responsibility of a clinical pharmacist to establish such a guideline with the approval of the Pharmacy and Therapeutics committee of the hospital and ensure that the conversion is done in tune with the guideline.
1.A clinical pharmacist should identify patients who receive IV medications and also recognize the need for IV medication in those patients and check for the indication.
2.Reviews the medication list against the IV to PO inclusion/exclusion criteria below to assess each patient’s eligibility.
3. If a patient meets criteria, fills out an IV to PO sticker (see image below) and place it in the patient’s chart in the Orders section.
4.The physician reviews the recommendation and signs and dates if in agreement. Then the pharmacist enters the new PO order and documents the intervention.
IV to PO inclusion/exclusion criteria
Consider the following criteria to identify residents that may be suitable candidates for an IV to PO conversion. Inclusion and Exclusion details were explained in the following table . Example of IV to Oral Conversion.
Listed below are a number of commonly used antibiotics known to have virtually equivalent bio availability when given by either the IV or PO routes. However, the final decision to convert a resident from IV to PO therapy should be based on the individual resident’s clinical condition and available laboratory data. Once switched, residents should be closely monitored for changing conditions over the next 24-48 hours.