Patients are often ordered intravenous (IV) medications when oral (PO) options are available, appropriate, and equally bioavailable. Common examples include antibiotics that are highly orally bioavailable (e.g., fluoroquinolones), oral potassium replacement (which is more effective than IV replacement), proton pump inhibitors (PPI) including in the setting of many cases of acute gastrointestinal bleeding, and oral vitamin B12 replacement (as opposed to intramuscular injections, including in the context of pernicious anemia). Peripheral catheters increase the risk of complications, including extravasation, infections, and thrombophlebitis. Furthermore, IV medication administration is often significantly costlier, decreases patient mobility, and increases length of hospital stay and pharmacist and nursing workload.

Conditions: Infection, gastrointestinal (GI) bleeding

Treatments: Intravenous (IV), oral (PO), antibiotics, potassium replacement, proton pump inhibitors (PPI), vitamin B12 replacement

Sources

• Butler CC, et al. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency: a systematic review of randomized controlled trials. Fam Pract. 2006 Jun;23(3):279-85. (PubMed)
• Choosing Wisely Canada. Association of Medical Microbiology and Infectious Disease Canada: Five Things Physicians and Patients Should Question [Internet]. 2015 Sep 4 [cited 2017 May 19]. Available from: http://www.choosingwiselycanada.org/recommendations/infectious-disease/.
• Cyriac JM, et al. Switch over from intravenous to oral therapy: a concise overview. J Pharmacol Pharmacother. 2014 Apr;5(2):83-7. (PubMed)
• Dellit TH, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007 Jan 15;44(2):159-77. (PubMed)
• Lau BD, et al. Budget impact analysis of conversion from intravenous to oral medication when clinically eligible for oral intake. Clin Ther. 2011;33(11):1792-6. (PubMed)
• Tsoi KK, et al. Meta-analysis: comparison of oral vs. intravenous proton pump inhibitors in patients with peptic ulcer bleeding. Aliment Pharmacol Ther. 2013 Oct;38(7):721-8. (PubMed)