Indications for initial IV route of antibiotics

Start IV antibiotic therapy (including gentamicin) within 1 hour of recognition of sepsis or severe infection in the clinical area where the diagnosis has been made. Each hour of delay in administering IV antibiotic therapy is associated with increasing mortality. Indications for IV (within 1 hour) are:

• Sepsis or deteriorating clinical condition due to bacterial infection irrespective of site.
• Fever and neutropenia / immunosuppression.
• Infection where initial IV therapy is mandatory; endocarditis, CNS infection, S. aureus bacteraemia, vascular graft infection.
• Infection where initial IV therapy is usual; severe pneumonia, bronchiectasis, bone/joint infection, intra-abdominal infection, deep abscess.
• Skin and soft tissue infection; IV therapy if sepsis or ≥2 of heat, erythema, induration/swelling (IV usually for 48-96 hours).
• Infection requiring antibiotics but oral route compromised (nil by mouth, reduced gastrointestinal absorption, mechanical swallowing disorder, vomiting, unconscious, no oral antibiotic formulation)

Guideline reviewed: June 2021

Page updated: March 2022