When can patients with community-acquired pneumonia (CAP) be treated with intravenous-to-oral switch therapy?

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

Answer

Inpatients with nonsevere community-acquired pneumonia (CAP) can be effectively and safely treated with oral antimicrobials from the time of admission, whereas those with severe pneumonia can be treated with early switch therapy. Once a hospitalized patient with CAP is clinically stable, switching from intravenous to oral antibiotics, even if the bacteremia was initially documented to be caused by S pneumoniae, is safe.

Numerous factors must be weighed before switching hospitalized patients from intravenous to oral antibiotics. In a study by Halm et al, the following factors were rated as very important to the antibiotic conversion decision [50] :

  • Absence of suppurative infection (93%)

  • Ability to maintain oral intake (79%)

  • Respiratory rate at baseline (64%)

  • No positive blood culture findings (63%)

  • Normal temperature (62%)

  • Oxygenation at baseline (55%)

  • Mental status at baseline (50%)


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