Switching from intravenous (IV) to oral antibiotics in patients with community-acquired pneumonia (CAP), who are clinical stable, had shorter length of hospital stay and also required shorter duration of antibiotic treatment, according to a study published in the journal Clinical Infectious Diseases.¹ Just 6% of the patients were early switchers, despite clinical practice recommendations to do so.

A retrospective study of adult patients with community-acquired pneumonia (CAP) was conducted to compare the impact of early switching to oral antibiotics with duration of hospitalization, in-hospital mortality at 14 days, late ICU admission and hospital costs as the main outcomes. These patients had been treated with IV antibiotics at 642 hospitals from 2010 to 2015. For the study, early switching was defined as discontinuation of IV antibiotics and starting oral antibiotics by the third day of hospitalization without interruption of treatment.

Out of the 378,041 patients enrolled in the study, 116,118 (30.7%) were switched to oral antibiotics prior to discharge. Of these, 21,784 (6%) were switched to oral antibiotics on the third day of hospitalization and were identified as early switchers. The antibiotic most frequently chosen for early switching belonged to the fluoroquinolone group. Patients who had been switched early from IV to oral antibiotics had shorter length of hospital stay (risk-adjusted ratio of means 0.44) and also required antibiotics, including IV antibiotics (risk-adjusted ratio of means 0.88), for fewer days. The hospital costs were also lower in this group of patients (risk-adjusted ratio of means = 0.84).

However, the 14-day mortality (risk-adjusted ratio of means 0.65) and need for late intensive care (risk-adjusted ratio of means = 0.66) were comparable between early switchers and other patients.

Patients who had higher predicted risk of mortality had higher probability of continuing with IV antibiotics. However, even among hospitals with high switch rates, fewer than 15% of very low risk patients were found to be switched early.

This study highlights that regardless of the evident benefits and safety of early switch to oral antibiotics, early switching to oral antibiotics in CAP patients when patients are clinically stable, was less prevalent. “Many more patients could be switched early without compromising outcomes”, the authors suggest.

References

1. Deshpande A, et al. Intravenous to oral antibiotic switch therapy among patients hospitalized with community-acquired pneumonia. Clin Infect Dis. 2023 Apr 3;ciad196. doi: 10.1093/cid/ciad196.
2. https://www.healio.com/news/infectious-disease/20230421/switch-from-iv-to-oral-antibiotics-associated-with-shorter-hospital-stays-treatment-length. April 23, 2023. Accessed on April 24, 2023.