How do different approaches to intravenous-to-oral switch therapy in the treatment of community-acquired pneumonia (CAP) affect outcomes?

Updated: Jul 30, 2018
  • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

Patient treatment guidelines and critical pathways are becoming widespread in disease management, and CAP is one disease in which prospective studies have demonstrated that a reduction in hospital stay is safe and agreeable with patients, caregivers, and administrators. Other treatment protocols are being explored, including a single dose of intravenous antibiotic prior to the oral switch and all-oral regimens using the newer fluoroquinolones. A study by Ramirez et al (2005) showed that the care recommended by national guidelines regarding switching from intravenous to oral therapy was not being appropriately delivered to adults with CAP in all regions of the world. [15]

Different doctors have different approaches to switch therapy. Inpatients with CAP treated by hospital clinicians had a shorter adjusted length of stay than those treated by primary care physicians, primarily because of earlier recognition of stability and more rapid conversion from intravenous to oral antibiotics. Adjusted costs were likewise reduced. However, patients treated by hospital clinicians were more often discharged with an unstable clinical variable. Other than earlier switching to oral antibiotics, less use of clindamycin and ceftazidime, and fewer consultations with infectious disease specialists, the care processes of hospital clinicians were similar to those of primary care physicians. [16]

In 2004, Wawruch et al reported on an evaluation of a group of patients selected out of 2870 patients who were hospitalized at the Clinic of Geriatric Medicine at Comenius University in Bratislava from January 1, 1999, to December 31, 2001. In their retrospective study, Wawruch et al analyzed 96 patients with CAP who were successfully treated with antibiotics. Forty-three patients received intravenous antibiotics, and 53 received IV-to-PO switch therapy (ie, intravenous administration was used at the beginning and oral administration was used when their conditions improved). [17]


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