NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

IVOST Guidelines

The following is a quote from Dr Andrew Seaton, Consultant in Infectious Diseases and General Medicine:

The Adult IV to Oral Antibiotic Switch Therapy (IVOST) guidelines have been updated.  The new 2018 IVOST Guidelines focus on IVOST for each commonly encountered infection in hospital rather than IVOST for a specific antibiotic, so emphasising the critical importance of establishing the diagnosis.

Why are we emphasising the 2018 IVOST Guidelines today?

1. GGC hospital audit data show c.70% of IV therapy is given for >72 hours and about half of these patients have not undergone a proper documented review of their treatment by that time.

2. Growing clinical evidence shows following guidelines including earlier IVOST and/or shorter duration therapy is:

a. SAFE & EFFECTIVE for many common infections including Pneumonia, COPD exacerbation, UTI,  Bone and joint infection, intra-abdominal sepsis and Gram negative bacteraemia (NB excluding S.aureus bacteraemia and endocarditis).

b. REDUCES RISK of vascular device infection, length of stay, time consuming drug reconstitution/administration for nursing staff and reduces antibiotic resistance.

What you need to do

1. Use the IVOST guideline to determine need for ongoing IV antibiotic therapy and to promote timely switch

2. REVIEW IV antibiotics daily and within 72 hours of starting therapy & RECORD in the case notes the outcome of this review, including reason for continued IV antibiotics (e.g. S.aureus bacteraemia)

3. Please ensure that the continued need for IV antibiotics are reviewed during weekend.

4. Record and LIMIT TOTAL duration of antibiotic therapy

Whilst IVOST is primarily the responsibility of the prescriber, ward nursing staff and clinical pharmacists also have an important clinical role in supporting appropriate prescribing. I would be grateful if this message could be shared widely with clinicians within your sectors. Very happy to share further information regarding local data/evidence base for this and other antibiotic guidance.

Most grateful for your support.


Published 16/05/18