Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

Medications Approved for Parenteral and Oral Route Interchange for AdultsParenteralRegimenParenteral Dose/Frequency Oral Regimen Oral Dose/Frequency NotesLevetiracetam 500-1500 mg IV twice daily Levetiracetam 500-1500 mg orally twice daily 1 to 1 dosingLevothyroxine 80 mcg IV q24h Levothyroxine 100 mcg orally daily Parenteral dose should beapproximately 80% of oraldose.Linezolid 600 mg IV q12h Linezolid 600 mg orally twice daily Use of linezolid is restrictedto ID approval1 to 1 dosingMetoclopramide 10 mg IV q6h Metoclopramide 10 mg orally q6h 1 to 1 dosingMetronidazole 500 mg IV q8h Metronidazole 500 mg orally three times daily 1 to 1 dosingMethylprednisolone 4 mg IV Prednisone 5 mg orallyMoxifloxacin 400 mg IV q24h Moxifloxacin 400 mg orally daily 1 to 1 dosingPantoprazole 40 mg IV Pantoprazole 40 mg orally 1 to 1 dosingPhenobarbital 15-20 mg/kg IV (loading) Phenobarbital NaStatus epilepticus1-3 mg/kg/day IV (2 divideddoses)1-3 mg/kg/day orally in 1-2 divided dosesPotassium Chloride 10 mEq - 40 mEq IV PotassiumChloride10 mEq - 40 mEq orally Only if patient isasymptomatic and K >3.2mmol/L1 to 1 dosingRanitidine 50 mg IV q8h Ranitidine 150 mg orally twice dailyRifampin 600 mg IV q24h Rifampin 600 mg orally daily 1 to 1 dosingTMP/SMZ320/1600 mg q12h TMP/SMZ320/1600 mg q12h160/800 mg q12h160/800 mg q12hValproic Acid 10-15mg/kg/day IV (divided q 6hrs)DivalproexVoriconazoleMaintenance dose - 4 mg/kg IVq12hVoriconazoleImmediate release 3-4x orally daily;delayed release 2-3 x orally daily;10-15mg/kg/day100 mg twice daily if pt weight 40 kgRound dose to nearesttablet strengthUse of voriconazole isrestricted to ID approval