Early Switch From Intravenous to Oral Antibiotics and Early Hospital Discharge

Abstract

Objectives: To determine the proportion of patients who can be treated with early switch to oral antibiotics and early discharge, to evaluate clinical outcome and patient satisfaction for patients treated with early switch and early discharge, and to define the factors that interfere with early discharge for some of the patients who underwent early switch to oral antibiotic therapy.Design: Prospective study.Participants: Two hundred consecutive hospitalized patients with community-acquired pneumonia.Main Outcome Measures: Number of days needed to switch to oral therapy and length of hospital stay. Clinical outcome and satisfaction with care were evaluated for those patients treated with early switch and early discharge.Results: Early switch to oral antibiotics (within the first 3 days of hospitalization) was performed in 133 patients (67%). Clinical failure was documented in 1 patient. Early switch and early discharge was performed 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 diagnostic workup. More than 95% of patients were satisfied with the care they had received. Conclusions:Using simple clinical and laboratory criteria, a significant proportion of hospitalized patients with community-acquired pneumonia (44%) can be treated with early switch and early discharge. This model did not affect patient outcome, decreased the length of hospitalization, and was associated with a high level of patient satisfaction.

Switch therapy in hospitalized patients with community-acquired pneumonia: Tigecycline vs. Levofloxacin

“…These data indicating early clinical stability in a significant number of hospitalized patients with CAP, are similar to those reported in prior studies on CAP [15-18]. It is important to recognize these groups of patients with early clinical improvement since they can be targeted for an approach for early switch therapy and early hospital discharge.…”

“…The majority of patients with non-severe disease can switch from IV to oral therapy within 2–4 days. Previous prospective studies of hospitalized CAP patients have shown that clinical cure rates with switch therapy were high [15-17], even in patients whose pneumonia is complicated by bacteremia [18]. Switch therapy also has health economic benefits via reduction in costs due to drug administration and decreased length of hospital stay [13].…”

Pharmacokinetic Alterations of Antimicrobials in the Critically Ill

“…Many institutions have developed successful intravenous to oral (IV to PO) conversion programs, particularly for disease states such as community-acquired pneumonia, to decrease length of stay and medication costs without adversely affecting treatment outcomes. 18,19 Most commonly, agents such as azithromycin and levofloxacin are used. A successful IV to PO conversion program will account for the various factors that may alter absorption in critically ill patients, the patient's clinical response, and prudent antimicrobial selection to ensure optimal treatment of the infection.…”

Understanding the Natural History of Community-Acquired Pneumonia Resolution: Vital Information for Optimizing Duration of Therapy

“…Some studies have defined how long it takes for a group of patients to reach "clinical stability" [2][3][4] and what factors are associated with achievement of this end point at either early or late dates. Other studies have examined the reasons for nonresponse, as well as the clinical consequences [5][6][7][8].…”

“…Ramirez and colleagues documented the rapid development of clinical stability during CAP therapy, but they demonstrated that this process was slower when bacteremic pneumococcal infection was present, compared with nonbacteremic infection [2,3]. Halm et al [4] found that severity of illness at the time of hospital admission, defined by the PSI, helped determine the rate of resolution of clinical findings, with patients with pneumonia of classes IV and V taking longer to reach stability than patients with pneumonia of classes I-III.…”