Greater Glasgow and Clyde Medicines

Therapeutics Handbook: Additional Update Jan 19

There has been a content update to two guidelines within the Infections chapter of the GGC Medicines Adult Therapeutics Handbook including the following main changes:

IV-Oral Antibiotic Switch Therapy (IVOST) Guideline 

The criteria for changing IV antibiotics to oral antibiotics have been simplified.

a.  If a patient with uncomplicated infection is improving, with a reduction in NEWS score, improving SEPSIS (temperature ≤37.9 oC), eating and drinking then they can be changed to oral antibiotic therapy.

b.  Examples of complicated infection requiring specialist advice prior to IVOST include CNS infection, Cystic Fibrosis, S. aureus bacteraemia (minimum of 14 days IV required), Endocarditis, Vascular graft or Bone/ joint infection, undrainable deep abscess)

c.  The IVOST oral antibiotic switch is now based on diagnosis; highlighting the oral antibiotic to change to based on the patient’s diagnosis.

Vancomycin dosing guidelines (for patients aged ≥16 years)

Changes in the Vancomycin section have been made to allow more convenient vancomycin dosing times for both the patient (and nursing staff).

In order to prevent the patient needing to be woken up in the middle of the night to be given Vancomycin, the first maintenance dose can be brought forward to a more convenient time (see table below). The first maintenance dose can be prescribed as follows:


Vancomycin Dose Interval (Hours)

Time Window for starting FIRST Vancomycin maintenance dose


6-12 hours post loading dose


18-24 hours post loading dose


36-48 hours post loading dose

For example if 12 hourly Vancomycin  dosing is recommended,  and the loading dose of Vancomycin was given at 3pm, then the next maintenance dose can be given at 10pm, then subsequently at 10am.

If you have not already done so please update your App on receipt of the notification. If you are not able to update your app then please refer to the GGCMedicines desktop site here as the website content is always live with the most up to date information. For more information contact the Antimicrobial Management Team. For assistance with any aspect of the GGC Medicines app or Therapeutics handbook please contact


Published 01/02/19. Medicines Update blogs are correct at the time of publication.

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