What is the efficacy of early implementation of 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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Regarding the management of CAP, Ramirez reported in 2001 that switch therapy can reduce costs associated with drug administration and length of hospital stay. He stated that switch therapy can be safely implemented when the following 4 criteria are met: (1) cough and respiratory distress improve, (2) fever abates for at least 8 hours, (3) the WBC count is returning to within the reference range, and (4) the patient can take drugs orally. In prospective clinical studies conducted at his institution, the clinical cure rate with switch therapy was 99% and the mean length of hospital stay was reduced by more than 2 days. Early switch, coupled with hospital discharge, may be possible in nearly half of all patients with CAP. Ramirez concluded that universal use of switch therapy in the United States could result in a total reduction of approximately 440,000 hospital days annually and an overall savings of $400 million. [51]

In 1999, Ramirez and colleagues studied early switching to oral antibiotics (within the first 3 d of hospitalization) in 133 patients (67%). Clinical failure was documented in 1 patient. Early switch and early discharge was achieved in 88 patients (44%). The mean length of hospital stay for this group was 3.4 days. The most common reason for prolonged hospitalization after the switch to oral antibiotics was the need for a diagnostic workup. More than 95% of patients were satisfied with the care they had received. Ramirez and colleagues concluded that, based on simple clinical and laboratory criteria, a significant proportion of hospitalized patients with CAP (44%) can be treated with early switch and early discharge. This model did not affect patient outcome, but it did decrease the length of hospitalization and was associated with a high level of patient satisfaction. [52]

Early IV to oral switch protocols can aid in the care and discharge planning in patients with prosthetic hip infection that was treated with 1- or 2-stage replacement. [53]

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