PATIENTS with pneumonia who were switched from intravenous (IV) to oral antibiotics early had shorter hospital stays and fewer days on antibiotics, reveals a novel retrospective study by Abhishek Deshpande and colleagues, from the Department of Infectious Diseases at the Centre for Value-Based Care Research, Cleveland Clinic, Ohio, USA. A thorough understanding of the prompt transition from IV to oral antibiotics in patients with pneumonia, as soon as they are clinically stable, is required to substantiate guideline recommendations and gather evidence to drive duality improvement efforts. Hence, this is the first large-scale study evaluating the switch from IV to oral antibiotics across hospitals in the USA.
Deshpande and colleagues investigated adults admitted with community-acquired pneumonia who were initially treated with IV antibiotics at any of 642 USA hospitals between 2010–2015. ‘Early switchers’ were considered as patients who were treated with a discontinuation of IV antibiotics and initiation of oral antibiotics without interruption by Day 3 in hospital. Length of stay, in-hospital 14-day mortality, late deterioration, intensive care unit transfer, and hospital costs were compared between early switchers and other patients.
Overall, 116,118 patients were switched to oral antibiotics before discharge; however, only 21,784 out of 378,041 patients with community-acquired pneumonia (5.8%) were considered early switchers. The findings revealed that the early switchers had fewer days on IV antibiotics, shorter duration of inpatient antibiotic treatment, shorter length of stay, and an overall lower hospitalisation cost. Early switchers and other patients displayed no significant differences in 14-day in-hospital mortality or late intensive care unit admission. Deshpande stated: “Hospitals must encourage clinicians to adhere to evidence-based recommendations for switching therapy in clinically stable pneumonia patients.” This can lead to shorter hospital stays and reduced antibiotic use without compromising patient outcomes.