IV/PO Switch

Question 1

Meningococcal bacteraemia duration of therapy

Answer 1

4 -5 days

Question 2

Meningococcal bacteraemia PO switch option?

Answer 2

No

Question 3

Pneumococcal bacteraemia duration of therapy

Answer 3

7 - 10 days

Question 4

PO switch in Pneumococcal bacteraemia

Answer 4

Occult (no fever at 24 hours) - only oral antibiotics
Occult (fever at 24 hours) - switch after 24 hours once afebrile and improved
Non-occult (septic) - no oral switch, only IV

Question 5

Gram negative bacteremia duration of therapy

Answer 5

10 days (7 days for Salmonella non-typhi, 14 days for pseudomonas in HSCT)

Question 6

PO switch for gram negative bacteraemia?

Answer 6

None, only IV

Question 7

Staphylococcus aureus bacteraemia duration

Answer 7

7-14 days (MSSA 7 days, MRSA 14 days)

Question 8

Staphylococcus aureus bacteraemia PO switch

Answer 8

None, only IV

Question 9

Central venous catheter (CVC) associated
bacteraemia duration

Answer 9

7 days (if CONS in neonate, CVC removal if blood cultures positive after 72 hours of appropriate antibiotics). If line removed, and culture negative, 3 - 7 days

Question 10

Bacterial endocarditis duration

Answer 10

4-6 weeks depending on organism

Question 11

Viridans strep bacterial endocarditis

Answer 11

Viridans MIC <0.12 = 2 - 4 weeks
Viridans MIC >0.12 = 4- 6 weeks

Question 12

S Aureus bacterial endocarditis

Answer 12

MSSA uncomplicated: 4 weeks
MSSA complicated or MRSA: 6 weeks

Question 13

Bacterial meningitis oral switch

Answer 13

None, only IV

Question 14

N. meningitidis meningitis

Answer 14

5 - 7 days

Question 15

H. influenzae meningitis

Answer 15

7 - 10 days

Question 16

S. pneumoniae meningitis

Answer 16

10 - 14 days

Question 17

GBS meningitis

Answer 17

14 - 21 days

Question 18

Gram negative bacilli meningitis

Answer 18

21 days

Question 19

Listeria meningitis

Answer 19

21 days

Question 20

Brain abscess/subdural empyema duration

Answer 20

6 weeks duration

Question 21

Brain abscess PO switch

Answer 21

after 2 - 4 weeks IV if improving

Question 22

VP shunt infection duration

Answer 22

Uncomplicated: 10 days
Complicated: 21 days (multi-compartmental hydrocephalus,
ventriculitis, multiple organisms, severe peritonitis or
remaining prosthetic material)

Question 23

VP shunt infection PO switch

Answer 23

None

Question 24

Streptococcal pharyngitis duration

Answer 24

10 days (Penicillin), no need for IV

Question 25

Peritonsillar Abscess duration

Answer 25

10 days (1 -2 days IV following drainage)

Question 26

Otitis Media duration

Answer 26

5 days, up to 10 days if severe. Withhold antibiotics for 48 hours, less if <6 months.

Question 27

Retropharyngeal abscess duration

Answer 27

10 - 14 days (3- 5 days IV minimum)

Question 28

Mastoiditis duration

Answer 28

12 - 15 days (5 days IV)

Question 29

Acute bacterial sinusitis

Answer 29

7 days after improvement in symptoms, all PO unless unwell/septic

Question 30

Acute cervical lymphadenitis

Answer 30

5 - 7 days, IV for 2-3 days if rapidly spreading

Question 31

Community acquired pneumonia

Answer 31

No need for IV unless systemically unwell. 3 days mild, <7 days if moderate/severe and uncomplicated. If severe/uncomplicated, give IV initially (Severe/complicated: O2 sats<85%, shock receiving IV bolus, immunocompromise, chronic lung/heart disease)

Question 32

Ventilator associated pneumonia

Answer 32

Good clinical response: 7 days Non-fermentative Gram-negative bacilli in sputum: 10 days

Question 33

Pleural empyema

Answer 33

7 days, IV to PO switch once drain removed and afebrile for 1 - 2 days

Question 34

Lung abscess

Answer 34

4 - 6 weeks, IV to PO switch once clinically improving. Abscess >6cm: continue until resolved or cavity small and stable size

Question 35

Acute osteomyelitis

Answer 35

3 -4 weeks, IV for 3 -4 days if uncomplicated. If complicated (delayed presentation, associated wound or abscess): longer duration IV is likely to be required)

Question 36

Subacute or chronic osteomyelitis

Answer 36

If prosthetic material, needs IV initially. If not, then could just do PO. No consensus on duration

Question 37

Septic arthritis

Answer 37

2 -3 weeks total duration, 2 -4 days IV then PO

Question 38

Cellulitis

Answer 38

5 - 7 days. Mild can be all PO, Moderate to Severe need 1-3 days IV then PO switch once improving Mod/Severe = rapidly spreading erythema, tender, lymphangitis, systemic features

Question 39

Preseptal (periorbital) cellulitis

Answer 39

7 - 10 days total, 2 - 3 days IV initially then PO once getting better

Question 40

Orbital Cellulitis

Answer 40

7 - 10 days, 3 -4 days IV, PO switch once improving. Intra-orbital abscesses should be drained, with non operative management in selected patients

Question 41

Skin abscesses

Answer 41

0 days if drained.

Question 42

Superficial surgical site infection

Answer 42

5 - 7 days oral antibiotics if started

Question 43

Deep surgical site infection

Answer 43

No minimum recommendation, duration dependent on clinical improvement. If prosthetic material present, very prolonged antibiotics may be necessary (4 - 6 weeks of IV)

Question 44

Appendicitis – uncomplicated

Answer 44

Single pre-op dose, nil needed after surgery

Question 45

Appendicitis – complicated, intra-abdominal infection

Answer 45

3-7 days total, initial IV. PO once improving and bowel function back

Question 46

Acute cholangitis

Answer 46

No clear recommendation around duration or IV/PO switch

Question 47

Pancreatitis

Answer 47

The only evidence for antibiotic use in pancreatitis in children is for treatment of established infection If complications of bacteraemia or pneumonia occu

Question 48

Necrotising enterocolitis

Answer 48

7-10 days with further duration if lack of clinical improvement. All intravenous

Question 49

UTI

Answer 49

3 -4 days, all PO unless <3 months who should initially get IV

Question 50

Pyelonephritis

Answer 50

7 - 10 days (7 days if improving. PO generally, IV only if <3 months or not tolerating PO

Question 51

Epididymitis

Answer 51

Negative urinalysis: no antibiotic Positive urinalysis: oral antibiotic for 2 weeks