| If Medication Ordered As | This is the Approved Interchange | Date of M.A.C. Approval |
|---|---|---|
| Azithromycin 500mg IV q24h | Azithromycin 250mg PO q24h (as per IV to PO Stepdown policy 038-MED) | 05.17 |
| Ampicillin p.o. q6h | Amoxacillin p.o. gram for gram q8h | 05.90 |
| Cephalothin IV/IM q6h | Cefazolin IV/IM gram for gram q8h | 05.90 |
| Cefotaxime 1g IV q8h or q12h *for moderate infections (e.g., Community acquired pneumonia) | Ceftriaxone 1g IV q24h (no dosage adjustment for renal impairment) | 04.97 |
| Cefotaxime 2g IV q8h or q12h *for serious infections (e.g., sepsis) | Ceftriaxone 2g IV q24h (no dosage adjustment for renal impairment) | 04.97 |
| Cefotaxime 2g IV q6h or q4h *for patients with meningitis or typhoid fever | Ceftriaxone 2g IV q12h (no dosage adjustment for renal impairment) | 04.97 |
| Ciprofloxacin (dose dependent on organism/infection) 400mg IV q8h 400mg IV q12h 200mg IV q12h | Ciprofloxacin (as per IV to po Stepdown policy 038-MED) 750mg PO q12h 500mg- 750mg PO q12h 250mg PO q12h | 05.17 |
| Clindamycin 600mg IV q8h | Clindamycin 300-450mg PO q6h (as per IV to PO Stepdown policy 038-MED) | 05.17 |
| Fluconazole (Dosage range based on weight, indication and renal function) X mg IV q24h | Fluconazole (as per IV to PO Stepdown policy 038-MED; same dose and frequency for IV and PO) X mg PO q24h | 05.17 |
| Fusidic Acid 2% cream | Polymyxin-bacitracin ointment (Polysporin®/Polytopic®/Polytracin®) | 9.15 |
| Gentamicin IV | Tobramycin IV milligram for milligram *Interchange applies only to susceptible cultures and empiric therapy* Note: Interchange does not apply to NICU orders and when being used for synergy in treatment of enterococal endocarditis. | 05.14 |
| Imipenem/Cilastin: 500mg Q6-8 H 1 G Q6-8 Xmg Q12H | Meropenem: 500mg Q6H 1 G Q8H X mg Q12H | 04.00 |
| Meropenem 1g IV TID Excluded from interchange if: Actual body weight > 2 times IBW Note: Meropenem 2g IV Q8H recommended if: neutropenic patients, CNS or eye infections, patients with cystic fibrosis | If CrCl greater than 50ml/min: Meropenem 500mg IV Q6H If CrCl 25-49ml/min: Meropenem 500mg IV Q8H If CrCl 10-24ml/min: Meropenem 500mg IV Q12H If CrCl less than 10ml/min: Meropenem 500mg IV Q24H If on hemodialysis: Meropenem 500mg IV Q24H, with dose administered after dialysis session If on continuous veno-venous hemodialysis (CVVHD) – dose as CrCl >50ml/min | 03.08 |
| Metronidazole 500mg IV qXh | Metronidazole (as per IV to po Stepdown policy 038-MED; same dose and frequency for IV and PO) 500mg PO qXh | 05.17 |
| Moxifloxacin 400mg IV q24h | Moxifloxacin 400mg PO q24h (as per IV to po Stepdown policy 038-MED) | 05.17 |
| Non urinary tract use Levofloxacin 500mg Levofloxacin 250mg Levofloxacin 750mg | Moxifloxacin 400mg | 10.04 |
| Nitrofurantoin 50-100mg po QID | Nitrofurantoin (Macrobid) 100mg po bid *interchange applies only to patients with ClCr above 50ml/min and who do not have an NG tube* | 09.12 |
| Nitrofurantoin orders for patient with NG tube | Nitrofurantoin tablets 50mg NG qid *interchange applies only to patients with ClCr above 50ml/min* | 09.12 |
| Polymyxin – bacitracin cream Bacitracin or gramicidin/neomycin/polymyxin combinations (Neosporin® ) Neomycin/bacitracin/IL cystein/DLthreominal glycine (Cicatrin® ) | Polymyxin-bacitracin ointment (Polysporin® /Polytopic® /Polytracin® ) | 06.96 |
Policy & Procedure
Revised:April/07
Revised: May/08
Revised: April/13, Dec/13, May/16, July/16, Aug/16, Oct/16, May/17, July/17, Nov/17
These policies are for internal use only at SJHH and are CONTROLLED documents as are all management system files on the intranet. Any documents appearing in paper form are not controlled and should ALWAYS be checked against the intranet version (electronic version) prior to use