Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

Table 1: Medications Approved for Parenteral and Oral Route InterchangeMedications Approved for Parenteral and Oral Route Interchange for AdultsParenteralRegimenParenteral Dose/Frequency Oral Regimen Oral Dose/Frequency NotesAmpicillin/Sulbactam 1.5 gm IV q6h Amoxicillin/ 500 mg/125 mg orally twice daily3 gm IV q6hClavulanate 875 mg/125 mg orally twice dailyAzithromycin 250 mg IV q24h Azithromycin 250 mg orally daily1 to 1 dosing500 mg IV q24h500 mg orally dailyCefazolin1 gm IV q8h Cephalexin 500 mg orally four times daily2 gm IV q8 h1000 mg orally four times dailyCefuroxime750 mg IV q8h Cefpodoxime 200 mg orally twice daily1.5 gm IV q8h or q12h Cefpodoxime 400 mg orally twice dailyCiprofloxacin 200 mg IV q12h Ciprofloxacin 250 mg orally twice daily400 mg IV q12h 500 mg orally twice daily400 mg IV q8h OR 600mg IV q12h750 mg orally twice dailyDexamethasone 2 mg IV Dexamethasone 2 mg orally1 to 1 dosing4 mg IV 4 mg orally6 mg IV 6 mg orally10 mg IV10 mg orallyDigoxin125 mcg IV q24h Digoxin125 mcg orally daily1 to 1 dosing250 mcg IV q24h250 mcg orally dailyDoxycycline 100 mg IV q12h Doxycycline 100 mg orally twice daily 1 to 1 dosingFosphenytoin 18-20 mg IV PE/kg (loading) Phenytoin18-20 mg/kg in 2-3 divided doses orally(given 2-4 hours apart use suspension orchew tabs)Fluconazole4-6 mg IV PE/kg/day100 mg IV q24h Fluconazole 100 mg orally daily200 mg IV q24h 200 mg orally daily400 mg IV q24h400 mg orally daily4-6 mg/kg/day in 2 divided doses orallywhen using chew tabs or suspension;1-2 divided doses orally when usingcapsules (once daily if dose < 400 mg)IncreaseIV/suspension/chew tabdose by 10% and round tonearest 100 mg & 30 mgcapsule strength whenconverting to capsules.Round to nearest 25 mg forchew tab and 50 mg forsuspension.1 to 1 dosing