9Costs and effects of early switch from IV to oral treatment in severe community-acquired pneumonia

Abstract:

Background: Early conversion of intravenous (IV) to oral antibiotic therapy in the treatment of mild and moderate community-acquired pneumonia (CAP) is assumed to reduce costs of antibiotics and length of hospital stay (LOS). However, efficacy and economic data from randomized trials are lacking and this strategy has not been evaluated for patients hospitalized with severe CAP (SCAP) Methods: Patients hospitalized in non-ICU wards with SCAP (Fine IV, V, or ATS-criteria for severe CAP) in 5 hospitals in the Netherlands were randomized to either 3 days IV therapy followed by 7 days oral antibiotics (intervention group) when clinically stable at day 3 (respiratory rate< 25/min, hemodynamically stable, resolution of fever, no mental confusion and able to take oral medication) or to 7 days IV antibiotics (control group). Choices of antibiotics reflected local treatment policies. Clinical cure and treatment costs both inside and outside the hospital were evaluated. Analyses were performed according to the intention-to-treat principle. Results: 302 patients were randomized (mean age 69.5±14.0, mean Fine score 112.7±26.0), 150 in the intervention group and 152 in the control group. In the intervention group, 106 (71%) were eligible for the IV to oral antibiotic switch at day 3. Mortality at day 28 was 4% in the intervention group and 6% in the control group (mean difference:-2%, 95% CI-8–-3%). Clinical cure at day 28 was 83% in the intervention group and 85% in the control group (mean difference-1.7, 95% CI–7–10%). Duration of IV therapy and length of hospital stay were reduced in the intervention group, with mean differences of 3.4 days (95% CI 2.8 …

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