Oral Step-Down

Patients on IV therapy can be switched safely to oral therapy once:

1. Hemodynamically stable
2. Improving clinically
3. Afebrile for 24 hours
4. Can ingest medications and have a functioning GI tract

In the absence of positive microbiology, recommended oral step-down of initial intravenous therapy is described below

Note: Complete concurrent course of azithromycin as appropriate

*Azithromycin duration is 500 mg for 3 days, or 500 mg once followed by 250 mg for 4 days. Longer duration may be necessary in Legionella infection.

Empiric vancomycin can be discontinued if nasal MRSA swab is negative, and no MRSA identified in blood or sputum cultures. Nasal MRSA swabs have a high negative predictive value in CAP