Evaluation of the timing of switch from intravenous to oral antibiotic therapy in community-acquired pneumonia during hospital admission: cohort study.

INTRODUCTION

Clinical guidelines recommend switching from intravenous to oral antibiotics in community-acquired pneumonia (CAP) once patients are clinically stable because it is safe and cost-effective. However, studies have reported low switching rates in clinical practice. This study aimed to assess current switch practices in the real-world setting.

METHODS

The switch from intravenous to oral antibiotic therapy was evaluated in adults (≥18 years) admitted to hospital with CAP. The primary outcome was a switch within 72 hours (early switch). Secondary outcomes included duration of hospital stays, readmissions, changes in inflammatory markers and mortality within 30 days after discharge. Furthermore, information on healthcare providers' decisions was gathered.

RESULTS

The cohort comprised 214 patients with CAP, of which 187 (87.4%) underwent a switch and 146 (68.2%) of these had an early switch. Early switching was frequent in younger patients (18-49 years) and those with low Pneumonia Severity Index (PSI I and II). Hospital stay was longer in the late and non-switch groups compared with the early switch group, and the total duration of antibiotic therapy was the highest in the late switch group. No reasons were documented for 76.5% (n=52) of the patients who did not undergo an early switch. Almost no early switches were advised during the weekends.

CONCLUSION

A high overall switch rate of 87.4% was observed with a 68.2% early switch rate. Early switch was associated with shorter duration of hospital stay and antibiotic therapy. Reasons for not applying an early switch were underreported, and weekends served as significant barriers to an early switch.