Antibiotic Therapy in Community-Acquired Pneumonia: Switch and Step Down Therapy

Hugh A. Cassiere, MD, Winthrop University Hospital


Medscape General Medicine. 1998;1(3) 

In This Article


Three treatment options are available for patients hospitalized with community-acquired pneumonia. The first, the traditional one, is to initiate with parenteral antibiotics and continue for the entire course. The second option is switch therapy -- starting with intravenous antibiotics and then changing to oral therapy. Finally, physicians may use oral antibiotics from the outset. Data on this latter treatment option are limited and more information will become available in the near future, especially when some of the newer antibiotics used to treat community-acquired pneumonia become clinically applicable.

Step down therapy is not only the initiation of oral antibiotics -- appropriate candidates must be identified and timing ascertained for the change-over. Attempting to predetermine conversion time (for example, at 3 days) should be replaced with the practice of dynamic evaluation (Fig. 2). Prospective, controlled studies are needed to validate the hypothetical benefits and limited risk of switch therapy for community-acquired pneumonia.

Flow chart outlining the management of patients with community-acquired pneumonia.