BACKGROUND: Early switch to oral antibacterials is recommended for the treatment of hospitalized patients with community-acquired pneumonia (CAP). However, its efficacy and safety in patients with more severe forms of CAP have not been well established. OBJECTIVE: To evaluate early switch to oral treatment in hospitalized patients with moderate to severe CAP. METHODS: Two reviewers independently extracted data from relevant randomized controlled trials (RCTs) with the same total duration of antibacterial treatment in the compared groups (early switch from intravenous to oral and conventional intravenous treatment for the whole duration of therapy). RESULTS: Six RCTs including 1219 patients fulfilled the criteria for inclusion in the meta-analysis. Treatment success was not different between early switch to oral treatment and intravenous only treatment groups in both intention to treat (odds ratio [OR] 0.76; 95% CI 0.36, 1.59) and clinically evaluable patients (OR 0.92; 95% CI 0.61, 1.39). Mortality and recurrence of CAP were not different (OR 0.81; 95% CI 0.49, 1.33 and OR 1.81; 95% CI 0.70, 4.72, respectively), while duration of hospitalization was shorter (weight mean difference -3.34; 95% CI -4.42, -2.25) and drug-related adverse events were fewer in the early switch group (OR 0.65; 95% CI 0.48, 0.89). Findings were similar in patients with severe CAP. CONCLUSIONS: Early conversion to oral antibacterials seems to be as effective as continuous intravenous treatment in patients with moderate to severe CAP and results in substantial reduction in duration of hospitalization.
BACKGROUND: Early switch to oral antibacterials is recommended for the treatment of hospitalized patients with community-acquired pneumonia (CAP). However, its efficacy and safety in patients with more severe forms of CAP have not been well established. OBJECTIVE: To evaluate early switch to oral treatment in hospitalized patients with moderate to severe CAP. METHODS: Two reviewers independently extracted data from relevant randomized controlled trials (RCTs) with the same total duration of antibacterial treatment in the compared groups (early switch from intravenous to oral and conventional intravenous treatment for the whole duration of therapy). RESULTS: Six RCTs including 1219 patients fulfilled the criteria for inclusion in the meta-analysis. Treatment success was not different between early switch to oral treatment and intravenous only treatment groups in both intention to treat (odds ratio [OR] 0.76; 95% CI 0.36, 1.59) and clinically evaluable patients (OR 0.92; 95% CI 0.61, 1.39). Mortality and recurrence of CAP were not different (OR 0.81; 95% CI 0.49, 1.33 and OR 1.81; 95% CI 0.70, 4.72, respectively), while duration of hospitalization was shorter (weight mean difference -3.34; 95% CI -4.42, -2.25) and drug-related adverse events were fewer in the early switch group (OR 0.65; 95% CI 0.48, 0.89). Findings were similar in patients with severe CAP. CONCLUSIONS: Early conversion to oral antibacterials seems to be as effective as continuous intravenous treatment in patients with moderate to severe CAP and results in substantial reduction in duration of hospitalization.
Authors: A Castro-Guardiola; A L Viejo-Rodríguez; S Soler-Simon; A Armengou-Arxé; V Bisbe-Company; G Peñarroja-Matutano; J Bisbe-Company; F García-Bragado Journal: Am J Med Date: 2001-10-01 Impact factor: 4.965
Authors: Lionel A Mandell; Richard G Wunderink; Antonio Anzueto; John G Bartlett; G Douglas Campbell; Nathan C Dean; Scott F Dowell; Thomas M File; Daniel M Musher; Michael S Niederman; Antonio Torres; Cynthia G Whitney Journal: Clin Infect Dis Date: 2007-03-01 Impact factor: 9.079
Authors: B J Marston; J F Plouffe; T M File; B A Hackman; S J Salstrom; H B Lipman; M S Kolczak; R F Breiman Journal: Arch Intern Med Date: 1997 Aug 11-25
Authors: Jan Jelrik Oosterheert; Marc J M Bonten; Margriet M E Schneider; Erik Buskens; Jan-Willem J Lammers; Willem M N Hustinx; Mark H H Kramer; Jan M Prins; Peter H Th J Slee; Karin Kaasjager; Andy I M Hoepelman Journal: BMJ Date: 2006-11-07
Authors: M Woodhead; F Blasi; S Ewig; J Garau; G Huchon; M Ieven; A Ortqvist; T Schaberg; A Torres; G van der Heijden; R Read; T J M Verheij Journal: Clin Microbiol Infect Date: 2011-11 Impact factor: 8.067
Authors: M F Engel; A H W Bruns; M E J L Hulscher; C A J M Gaillard; S U C Sankatsing; F Teding van Berkhout; M H Emmelot-Vonk; E M Kuck; M H M Steeghs; J H den Breeijen; R K Stellato; A I M Hoepelman; J J Oosterheert Journal: Eur J Clin Microbiol Infect Dis Date: 2014-05-26 Impact factor: 3.267
Authors: K de With; F Allerberger; S Amann; P Apfalter; H-R Brodt; T Eckmanns; M Fellhauer; H K Geiss; O Janata; R Krause; S Lemmen; E Meyer; H Mittermayer; U Porsche; E Presterl; S Reuter; B Sinha; R Strauß; A Wechsler-Fördös; C Wenisch; W V Kern Journal: Infection Date: 2016-06 Impact factor: 3.553
Authors: G Theocharis; P I Rafailidis; D Rodis; I Kontopidis; S G Barbas; M E Falagas Journal: Eur J Clin Microbiol Infect Dis Date: 2012-06-02 Impact factor: 3.267
Authors: Raquel K Belforti; Tara Lagu; Sarah Haessler; Peter K Lindenauer; Penelope S Pekow; Aruna Priya; Marya D Zilberberg; Daniel Skiest; Thomas L Higgins; Mihaela S Stefan; Michael B Rothberg Journal: Clin Infect Dis Date: 2016-04-05 Impact factor: 9.079
Authors: Dheeraj Gupta; Ritesh Agarwal; Ashutosh Nath Aggarwal; Navneet Singh; Narayan Mishra; G C Khilnani; J K Samaria; S N Gaur; S K Jindal Journal: Lung India Date: 2012-07
Authors: P F Dutey-Magni; M J Gill; D McNulty; G Sohal; A Hayward; L Shallcross; Niall Anderson; Elise Crayton; Gillian Forbes; Arnoupe Jhass; Emma Richardson; Michelle Richardson; Patrick Rockenschaub; Catherine Smith; Elizabeth Sutton; Rosanna Traina; Lou Atkins; Anne Conolly; Spiros Denaxas; Ellen Fragaszy; Rob Horne; Patty Kostkova; Fabiana Lorencatto; Susan Michie; Jennifer Mindell; John Robson; Claire Royston; Carolyn Tarrant; James Thomas; Jonathan West; Haydn Williams; Nadia Elsay; Chris Fuller Journal: JAC Antimicrob Resist Date: 2021-03-04