Intravenous/oral sequential therapy in patients hospitalised with community-acquired pneumonia: which patients, when and what agents?

Cost and pharmacoeconomic aspects are becoming more and more important in antibacterial therapy. Nevertheless, antibacterial therapy is curative and initial use of the right antibacterial with high activity and low resistance rates against the relevant pathogens can help to save costs. A new trend in antibacterial therapy is sequential therapy (intravenous/oral) in hospitalised patients with moderate to severe infections. Large studies comparing intravenous therapy with sequential therapy (intravenous/oral) have shown equivalence in clinical and bacteriological outcome. One main indication investigated is community-acquired pneumonia (CAP). CAP requires prompt and effective antibacterial treatment and conventional therapy for patients hospitalised with CAP has typically been parenteral antibacterial therapy for 7 to 10 days. However, clinical evidence shows that in most patients the objective and subjective indicators of infection are substantially improved within the first 2 to 3 days of treatment. Today a large number of clinical trials in patients with CAP have been undertaken and sequential therapy with appropriate antibacterials used in suitable patients has been proven as a treatment option. This demonstrates pharmacoeconomic benefits without compromising antibacterial efficacy. Recommended antibacterials for intravenous/oral sequential therapy in patients with CAP are second- and third- generation cephalosporins, aminopenicillins plus a beta-lactamase inhibitor, and new fluoroquinolones.