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."

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