Some IV to PO conversions are easy (linezolid, azithromycin), but some require more thought. If a provider wants some IV to PO suggestions, the following are some to consider. These choices can be more complex than a 1:1 conversion (for example, ceftriaxone IV to PO conversion for a UTI will likely be different than for pneumonia; though Augmentin is a choice for de-escalating meropenem, you wouldn’t use it if the patient cultured Pseudomonas). You should ensure your recommendations are susceptible or empirically cover commonly suspected organisms, based on the condition being treated and local sensitivities. There may also be options other than the ones listed.
| IV Drug | PO Possibilities |
| Acyclovir | Acyclovir |
| Ampicillin | Amoxicillin |
| Ampicillin / sulbactam | Amoxicillin / Clavulanic acid |
| Azithromycin | Azithromycin |
| Aztreonam | Ciprofloxacin/Levofloxacin |
| Cefazolin | Cephalexin |
| Cefepime | Cefdinir, Ciprofloxacin/Levofloxacin |
| Ceftazidime | Ciprofloxacin/Levofloxacin/Cephalexin (depending on indication) |
| Ceftriaxone | Amoxicillin, Amoxicillin / Clavulanic acid, Cefuroxime, Cefixime, Cefpodoxime, Ciprofloxacin/Levofloxacin + Flagyl, Nitrofurantoin for cystitis (depends on indication/locus) |
| Cefuroxime | Cefuroxime |
| Ciprofloxacin | Ciprofloxacin |
| Clindamycin | Clindamycin |
| Doxycycline | Doxycycline |
| Fluconazole | Fluconazole |
| Gentamicin | Ciprofloxacin/Levofloxacin, SMX/TMP, possibly Cefdinir (depends on indication/suspecibilties) |
| Tobramycin | Ciprofloxacin/Levofloxacin, SMX/TMP, possibly Cefdinir (depends on indication/suspecibilties) |
| Imipenem/cilastatin | Amoxicillin / Clavulanic acid, Ciprofloxacin/Levofloxacin + Augmentin OR Ciprofloxacin/Levofloxacin + clindamycin or metronidazole (depends on infection/susceptibility, need FQ for pseudomonas) – Nitrofurantoin, Pivmecillinam, Fosfomycin, and TMP-SMX have been shown to be effective options for ESBL-E cystitis |
| Levofloxacin | Levofloxacin |
| Linezolid | Linezolid |
| Meropenem | Amoxicillin / Clavulanic acid, Ciprofloxacin/Levofloxacin + Augmentin OR Ciprofloxacin/Levofloxacin + clindamycin or metronidazole (depends on infection/susceptibility, need FQ for pseudomonas) – Nitrofurantoin, Pivmecillinam, Fosfomycin, and TMP-SMX have been shown to be effective options for ESBL-E cystitis |
| Metronidazole | Metronidazole |
| Nafcillin | Amoxicillin / Clavulanic acid |
| Penicillin G | Pen VK |
| Piperacillin / tazobactam | Amoxicillin / Clavulanic acid, Ciprofloxacin/Levofloxacin + Amoxicillin / Clavulanic acid OR Ciprofloxacin/Levofloxacin + clindamycin or metronidazole (depends on infection/susceptibility, need FQ for pseudomonas) |
| Rifampin | Rifampin |
| SMX/TMP | SMX/TMP |
| Vancomycin | SMX/TMP, Doxycycline, Rifampin, Linezolid |