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Antibiotic Switches Lack Good Data, Report Says

Kate Traynor

Published research about community-acquired pneumonia (CAP) offers little guidance on whether early switching of patients from intravenous (i.v.) to oral antibiotics shortens the length of a hospital stay, say researchers.

After screening the titles of 1,794 CAP-related journal articles published between Jan. 1, 1980, and March 31, 2000, a research team identified 121 reports that focused on early-switch or early-discharge strategies. Of these reports, 10 prospective, interventional studies published between 1995 and 2000 met the research team’s standards. An analysis of these 10 studies appeared in the March 12 Archives of Internal Medicine.

According to the analysis, nine studies listed specific criteria for switching patients from i.v. to oral antibiotics. The only early-switch criterion common to all nine studies was resolution of a patient’s fever before the start of oral antibiotic therapy. But these studies, the research team said, used four definitions of normal temperature.

In eight of the nine studies with specific criteria, patients’ respiratory symptoms had to improve or resolve before oral antibiotic therapy would be started. Six studies required that patients be able to swallow medication.

Early-discharge strategies varied considerably among the five studies that defined specific criteria for early release. The most consistent requirement, used by four studies, was that any condition complicating a patient’s CAP had to be under control before discharge.

The researchers found no significant difference in the lengths of stay reported for the intervention and control groups by the six studies that used early-switch and early-discharge strategies and included control patients. However, when the researchers disregarded the two studies that set a longer minimum length of stay for the intervention groups than for the controls, the results showed that the patients who were switched early from i.v. to oral antibiotic therapy left the hospital three days sooner than the other patients. The two studies that were disregarded in this latter comparison were the largest ones examined by the researchers, accounting for 54 percent of the 249 intervention patients and 68 percent of the 240 controls.

Because of the variability in criteria found in the articles, the research team urged consensus on a minimum set of criteria for early-switch and early-discharge strategies and called for prospective studies aimed at determining whether such strategies can reduce the length of hospital stay for patients with CAP.