Study: More pneumonia patients could be switched early from IV to oral antibiotics

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A retrospective study of patients with community-acquired pneumonia (CAP) suggests many more could be switched early from intravenous (IV) to oral antibiotics without compromising outcomes, researchers reported this week in Clinical Infectious Diseases.

For the study, researchers from the Cleveland Clinic, Harvard Medical School, and the University of Massachusetts Medical School-Baystate analyzed data on adults admitted with CAP and initially treated with IV antibiotics at 642 US hospitals from 2010 through 2015. Patients who were switched from IV to oral antibiotics without interruption of therapy by hospital day 3 were considered early switchers. The main outcomes of interest were hospital length of stay (LOS), in-hospital 14-day mortality, late intensive care unit (ICU) admission, and hospital costs.

Of 378,041 CAP patients, 21,784 (5.8%) were switched from IV to oral antibiotics by day 3, and 116,118 (30.7%) were switched before discharge. Early switching was more common in large hospitals, teaching hospitals, and urban hospitals. Patients switched early had shorter LOS and lower hospitalization costs, as well as fewer days of IV antibiotic therapy and shorter duration of inpatient antibiotic treatment. There were no significant differences in 14-day in-hospital mortality or late ICU admission between early switchers and others.

Patients with lower predicted risk of mortality were more likely to be switched, but even in hospitals with relatively high switch rates, fewer than 15% of very low-risk patients were switched early.

The study authors say the findings suggest clinicians remain wary of switching CAP patients from IV to oral antibiotics, despite evidence of safety and recommendations from several medical organizations to do so when patients are clinically stable.

"Early switching appears safe but underused in patients with CAP," they wrote. "Our data suggests hospitals can reduce the burden of antibiotics delivered for CAP by encouraging clinicians to follow evidence-based recommendations to switch therapy in clinically stable patients."

Canada reports H5N1 avian flu in pet dog

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Canadian health officials yesterday announced that H5N1 avian influenza has been detected in a domestic dog, the country's first such case, adding to the list of mammal species infected in ongoing activity involving the 2.3.4.4b clade of the virus.

In a joint statement, the Canadian Food Inspection Agency and the Public Health Agency of Canada said the result from the dog was confirmed on April 1. The dog is from Oshawa, Ontario, located about 40 miles east of Toronto.

hunting dog
mandymin/iStock

The dog got sick after chewing on a dead goose and died. A necropsy revealed respiratory symptoms involvement, and further investigation is underway.

The groups said the number of documented cases in non-avian species is low, despite the fact that the virus has fueled large outbreaks in poultry over the past few years. They urged pet owners to avoid feeding pets raw meat from game birds or poultry and not allow them to eat or play with dead birds found outside.

When H5N1 outbreaks in poultry struck countries in Asia in 2005 and 2006, health officials in some countries, including Thailand, reported the virus in a few dogs and cats on the farms.

Quick takes: ECDC urges fall COVID boosters for risk groups, EUA for new monoclonal antibody, human trial results for Gilead COVID antiviral

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  • The European Centre for Disease Prevention and Control (ECDC) today released new guidance on COVID vaccination today, which encourages countries to conduct autumn booster campaigns targeting high-risk groups, including people ages 60 and older. It said modeling suggests that high uptake in the age group could cut hospitalizations by 32% in the region.
  • The US Food and Drug Administration (FDA) yesterday issued an emergency use authorization (EUA) for a new monoclonal antibody treatment (vilobelimab) from Germany-based InflaRx. The treatment, given by intravenous infusion, is indicated for adult patients who are hospitalized for their COVID infections.
  • Gilead Sciences yesterday reported promising findings for its oral antiviral drug obeldesivir as a treatment for COVID-19 infection, according to Reuters. The findings have paved the way for enrollment in phase 3 clinical trials. The phase 1 trial involved 70 healthy adults. The treatment is given as two tablets a day for 5 days. The company will present its data later this month at the European Congress of Clinical Microbiology and Infectious Diseases in Copenhagen.

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