Early IV to Oral antibiotic switching reduces LOS and antibiotics duration in Community-Acquired Pneumonia patients

A new study published in Clinical Infectious Diseases suggests that early intravenous (IV) to oral antibiotic switching was linked to lower length-of-stay (LOS) and fewer days on antibiotics, but it was not linked to poorer outcomes.

Hospital admissions and the usage of antibiotics are frequently caused by community-acquired pneumonia (CAP). Once patients are clinically stable, clinical practice guidelines advise moving from intravenous to oral antibiotics. In order to evaluate the impact of intravenous to oral antibiotic switch treatment among patients hospitalized with community-acquired pneumonia, Abhishek Deshpande and colleagues carried out this study.

Adults hospitalized with CAP who were initially treated with intravenous antibiotics in 642 US hospitals between 2010 and 2015 were the subject of a retrospective cohort research. Switching was defined as starting oral antibiotics without pausing therapy after stopping IV antibiotics. Early switchers were patients who made the changeover by day three in the hospital. Controlling for hospital factors, patient demographics, comorbidities, beginning therapies, and expected mortality, length-of-stay (LOS), in-hospital 14-day mortality, late deterioration (ICU transfer), and hospital expenditures were compared between early switchers and others.

The key findings of this study were;

1. 21,784 (6%) of 378,041 CAP patients had an early transition.

2. Fluoroquinolones were the most commonly used drug switch for patients.

3. Patients who switched over earlier experienced a shorter length of stay (LOS), fewer days on IV antibiotics, and reduced hospitalization costs.

4. Between early switchers and other patients, there were no appreciable changes in 14-day in-hospital mortality or late ICU admission.

5. Even in facilities with very high switch rates, 15% of extremely low risk patients were switched early.

6. Patients with higher estimated mortality risk were less likely to be switched.

15% of patients with extremely minimal risk were switched early, even in hospitals with high switch rates. The results imply that many more patients might be switched early without having an adverse effect on results.

Reference:

Deshpande, A., Klompas, M., Guo, N., Imrey, P. B., Pallotta, A. M., Higgins, T., Haessler, S., Zilberberg, M. D., Lindenauer, P. K., & Rothberg, M. B. (2023). Intravenous to Oral Antibiotic Switch Therapy among Patients Hospitalized with Community-Acquired Pneumonia. In Clinical Infectious Diseases. Oxford University Press (OUP). https://doi.org/10.1093/cid/ciad196