National antimicrobial intravenous-to-oral switch (IVOS) criteria for prompt switch for adults
Updated 4 April 2024
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This publication is available at https://www.gov.uk/government/publications/antimicrobial-intravenous-to-oral-switch-criteria-for-early-switch/national-antimicrobial-intravenous-to-oral-switch-ivos-criteria-for-early-switch
The national antimicrobial intravenous-to-oral switch (IVOS) criteria for prompt switch contains 24 IVOS criteria categorised into 5 sections. This criteria was co-produced through a UK-wide consensus process involving 279 multidisciplinary participants.
Timing of intravenous (IV) antimicrobial review
IVOS should be considered within 48 hours of the first dose of IV antimicrobial being administered.
If no IVOS within first 48 hours, review daily thereafter.
Clinical signs and symptoms
Clinical signs and symptoms of infection are improving.
Infection markers
Temperature has been between 36 to 38°C for the past 24 hours.
Early Warning Score is decreasing.
White Cell Count is trending towards the normal range.*
C-Reactive Protein is decreasing.*
*Note: these infection markers could also indicate inflammation or be affected by, for example, steroid treatment; ‘Prompt for switch’ or ‘Assess for switch’ may still occur if they are the only markers not met.
Enteral route
Gastrointestinal tract must be functioning with no evidence of malabsorption.
Safe swallow or enteral tube administration.
Suitable oral switch option available, considering oral bioavailability, any clinically significant drug interactions or patient allergies.
No significant concerns over patient adherence to oral treatment.
No vomiting within the last 24 hours.
Special considerations
Special considerations are:
- deep-seated infection
- infection requiring high tissue concentration
- infection requiring prolonged intravenous antimicrobial therapy
- critical infection with high risk of mortality
Specific infections for special consideration are:
- bloodstream infection
- empyema
- endocarditis
- meningitis
- osteomyelitis
- severe or necrotising soft tissue infections
- septic arthritis
- undrained abscess
Antimicrobial IVOS criteria and tool – project information
These IVOS criteria have been developed through:
- collation of criteria from a sample of 45 acute hospital IVOS policies
- completion of a rapid systematic literature review to validate selection of IVOS criteria
- 4-step Delphi consensus-gathering process involving 279 multidisciplinary participants from all UK nations to agree evidence-based, UK-wide IVOS criteria for hospitalised adult patients
The Delphi process consisted of:
- Step 1: pilot/first round questionnaire (24 respondents)
- Step 2: virtual meeting to discuss findings of pilot/first round questionnaire (15 participants)
- Step 3: second round questionnaire (242 respondents)
- Step 4: workshop (48 pre-workshop survey respondents and 33 workshop participants)
The total of 279 participants across the 4-step process accounts for individuals who provided expert advice outside of questionnaires, virtual meeting and workshop, and ensures individuals who participated in more than one step are only included once in total count.
This project has been led by the UK Health Security Agency (UKHSA)’s Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use and Sepsis Division, in collaboration with NHS England AMR Programme and UKHSA’s Behavioural Science and Insights Unit.