Moving from intravenous to oral antibiotics in complicated urinary infection is safe in the right patient, and the right patient is identifiable at the bedside. Look for resolution of fever for at least 24 to 48 hours, stable haemodynamics, falling inflammatory markers, the ability to take and absorb oral medication, and a source that has been controlled, such as relief of obstruction or removal of an infected catheter. Choose an oral agent to which the organism is susceptible, check renal function for dosing, and plan the total course length from the start of effective therapy.
- Confirm afebrile for 24 to 48 hours with stable observations
- Make sure any obstruction or infected catheter has been dealt with
- Choose an oral agent with confirmed susceptibility and adjust for renal function
- Count total duration from the first day of effective therapy
Why it matters
Unnecessary intravenous days add line infections, cost and carbapenem pressure.
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