What is the efficacy of intravenous-to-oral switch therapy in the treatment of community-acquired pneumonia (CAP)?

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

Answer

According to the cost-effectiveness coefficient, the switch therapy was significantly less expensive in all evaluated antibiotics (except pefloxacin) compared with intravenous administration. For ampicillin-sulbactam, the coefficients were 93.9 versus 168.1, 90 versus 123.3 for cefuroxime, 74 versus 116.3 for amoxicillin-clavulanate, and 31.7 versus 54.1 for ciprofloxacin. Wawruch et al found that timely switching from intravenous to oral administration of antibiotics in suitable patients is an effective way to save financial resources. [17]

Oosterheert et al (2006), based on a study of 302 patients, found that early switch from intravenous to oral antibiotics in patients with severe CAP is safe and decreases the hospital stay by 2 days. [18]

Peyrani et al (2006) reported that, in a study involving 40 hospitals in 13 countries, IV-to-PO switch antibiotic therapy among hospitalized patients with CAP did not comply with evidence-based guidelines implemented by The American Thoracic Society and the Infectious Diseases Society of America. [19]

Rhew and associates investigated the effectiveness of early switch and early discharge strategies in patients with CAP by searching the MEDLINE, HealthStar, EMBASE, Cochrane Collaboration, and Best Evidence databases for the period between January 1, 1980, and March 31, 2000, for CAP studies that included specific switch criteria or recommendations to switch on a particular day. [20]

Rhew et al identified 1794 titles and reviewed 121 articles. They identified 10 prospective, interventional, CAP-specific studies that evaluated length of stay. Nine studies applied an early switch from parenteral to oral antibiotic criteria. Six different criteria for switching were applied in the 9 studies. Five of the studies that applied early-switch criteria also applied separate criteria for early discharge. Six studies applied an early-switch and early-discharge strategy to an intervention and a control group, and 5 of these provided standard deviation values for length of stay. [20]

The mean change in length of stay was not significantly (P = .05) reduced in studies of early switch and early discharge (-1.64 d; 95% CI, -3.3 to 0.02 d). However, when the 2 studies in which the recommended length of stay was longer than the control length of stay were excluded from the analysis, the mean change in length of stay was reduced by 3 days (-3.04 d; 95% CI, -4.9 to -1.19 d). Studies did not reveal significant differences in clinical outcomes between the intervention and control groups. Rhew and colleagues concluded that criteria for early switching from parenteral to oral antibiotics vary considerably for patients with CAP. Early-switch and early-discharge strategies may significantly and safely reduce the mean length of stay when the recommended length of stay is shorter than the actual length of stay. [20]


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