A prospective randomized study of inpatient iv. antibiotics for community-acquired pneumonia. The optimal duration of therapy.
OBJECTIVE
To compare therapeutic outcome and perform a cost-benefit analysis of inpatients with community-acquired pneumonia (CAP) treated with a shortened course of i.v. antibiotic therapy.


METHODS
A prospective, randomized, parallel group study with a follow-up period of 28 days.


METHODS
Bronx Veterans Affairs Medical Center (VAMC) and the Castle Point VAMC; university-affiliated VAMC general medical wards from September 1993 to March 1995.


METHODS
Seventy-two male veterans and 1 female veteran with 75 episodes of CAP defined by a new infiltrate on chest radiograph and either history or physical findings consistent with pneumonia. Study population was 42%(31) black, 33%(24) white, and 25%(18) Hispanic.


METHODS
Patients were randomized (1:1:1) to 1 of 3 treatment groups: group 1 received 2 days of i.v. and 8 days of oral therapy; group 2 received 5 days of i.v. and 5 days of oral therapy; and group 3 received 10 days of i.v. therapy. Antibiotics consisted of cefuroxime, 750 mg every 8 h for the i.v. course, and cefuroxime axetil, 500 mg every 12 h for the oral therapy.


RESULTS
No differences were found in the clinical course, cure rates, or resolution of chest radiograph abnormalities among the three groups. A significant difference was found in the length of stay (LOS) among the three groups. The mean +/- SD LOS was 6 +/- 3 days in group 1, 8 +/- 2 days in group 2, and 11 +/- 1 days in group 3. The shortened LOS could potentially save $95.5 million for the Department of Veterans Affairs and $2.9 billion for the US private sector.


CONCLUSIONS
Adult patients hospitalized for CAP who are not severely ill can be successfully treated with an abbreviated (2-day) course of i.v. antibiotics and then switched to oral therapy. A longer course of i.v. therapy prolongs hospital stay and cost, without improving the therapeutic cure rate.
Siegel
R E
RE
Department of Pulmonary and Critical Care Medicine, Bronx (NY) Veterans Affairs Medical Center 10468, USA.
Halpern
N A
NA
Almenoff
P L
PL
Lee
A
A
Cashin
R
R
Greene
J G
JG
D000328:Adult; D000368:Aged; D002444:Cefuroxime / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use*; D017714:Community-Acquired Infections; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy* / Q000191:economics; D011446:Prospective Studies; D013997:Time Factors
D002511:Cephalosporins; D002444:Cefuroxime; C040738:cefuroxime axetil