Managing antiinfective therapy of community-acquired pneumonia in the hospital setting: focus on switch therapy.

Targeting patients for early switch from intravenous to oral antibiotic therapy and early hospital discharge is an important strategy in the management of community-acquired pneumonia (CAP). This strategy can reduce costs due to drug administration and length of hospital stay. We show that switch therapy can be implemented safely when four criteria are met: cough and respiratory distress improve, fever abates for at least 8 hours, white blood cell count is returning to normal, and patient can take drugs orally In prospective clinical studies conducted at our institution, the clinical cure rate with switch therapy was 99%, and mean length of hospital stay was reduced by more than 2 days. Early switch, coupled with hospital discharge, may be possible in nearly half of all CAP patients. Universal use of switch therapy in the United States could result in the total reduction of about 440,000 hospital days annually and an overall savings of $400 million.