Guidance

National criteria for prompt intravenous-to-oral switch (IVOS) of antimicrobials in children and young people (including newborns)

Updated 25 October 2024

See Antimicrobial IVOS decision aid for paediatrics

The national criteria for prompt intravenous-to-oral switch (IVOS) of antimicrobials in children and young people, including newborns, contains 29 IVOS criteria categorised into 5 sections. These criteria were co-produced through a UK-wide consensus process involving 170 multidisciplinary participants.

National antimicrobial IVOS criteria for adults is also available.

Timing of intravenous antimicrobial review​

IVOS should be considered within 48 hours of the first dose of intravenous (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.​

Temperature has been between 36 and 38°C for the past 24 hours.​

Paediatric Early Warning Score is decreasing.

Infection markers ​

White cell count is trending towards normal range.

C-reactive protein is decreasing.

Enteral route​

Gastrointestinal tract must be functioning with no evidence of malabsorption.​

Safe swallow or enteral tube administration.​

Suitable alternative switch option available, considering spectrum of microbiological activity, oral bioavailability, palatability, 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

The following criteria may require special consideration in the context of a switch within 48 hours. However, on specialist advice, an IVOS within 48 hours may still be indicated for some patients with these infections.

Special considerations are:

• deep-seated infection

• infection requiring high tissue concentration that is not achievable via oral antibiotics
• infection requiring prolonged intravenous antimicrobial therapy
• critical infection with high risk of mortality (for example, sepsis requiring inotropes or ventilation)
• patient aged 28 days and under (neonate)
• patient is considered severely immunocompromised
• patient is admitted on paediatric intensive care unit

Specific infections for special consideration are:

• bloodstream infection
• empyema
• endocarditis
• meningitis
• osteomyelitis
• severe or necrotising soft tissue infections
• septic arthritis
• undrained abscess
• exacerbation of cystic fibrosis or bronchiectasis
• central venous catheter-associated infection

Antimicrobial IVOS criteria and tool – project information

These IVOS criteria have been developed through:​

• completion of a rapid systematic literature review to validate selection of IVOS criteria​
• web-based survey for consensus-gathering involving 170 multidisciplinary participants from all UK nations to agree evidence-based, UK-wide IVOS criteria for hospitalised paediatric and neonate patients​

The criteria for children and young people, including newborns differ from the IVOS criteria for adults, with the addition of palatability of the alternative switch option, and the following special considerations:

• patient aged 28 days and under (neonate)
• patient is considered severely immunocompromised
• patient is admitted on paediatric intensive care unit
• exacerbation of cystic fibrosis or bronchiectasis
• exacerbation of central venous catheter-associated infection

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.

Clinicians can access the IVOS Commissioning for Quality and Innovation (CQUIN) data collection tool on the FutureNHS website.