Effectiveness of early switch from intravenous to oral antibiotics in severe community acquired pneumonia: multicentre randomised trial.
OBJECTIVE
To compare the effectiveness of an early switch to oral antibiotics with the standard 7 day course of intravenous antibiotics in severe community acquired pneumonia.


METHODS
Multicentre randomised controlled trial.


METHODS
Five teaching hospitals and 2 university medical centres in the Netherlands.


METHODS
302 patients in non-intensive care wards with severe community acquired pneumonia. 265 patients fulfilled the study requirements.


METHODS
Three days of treatment with intravenous antibiotics followed, when clinically stable, by oral antibiotics or by 7 days of intravenous antibiotics.


METHODS
Clinical cure and length of hospital stay.


RESULTS
302 patients were randomised (mean age 69.5 (standard deviation 14.0), mean pneumonia severity score 112.7 (26.0)). 37 patients were excluded from analysis because of early dropout before day 3, leaving 265 patients for intention to treat analysis. Mortality at day 28 was 4% in the intervention group and 6% in the control group (mean difference 2%, 95% confidence interval -3% to 8%). Clinical cure was 83% in the intervention group and 85% in the control group (2%, -7% to 10%). Duration of intravenous treatment and length of hospital stay were reduced in the intervention group, with mean differences of 3.4 days (3.6 (1.5) v 7.0 (2.0) days; 2.8 to 3.9) and 1.9 days (9.6 (5.0) v 11.5 (4.9) days; 0.6 to 3.2), respectively.


CONCLUSIONS
Early switch from intravenous to oral antibiotics in patients with severe community acquired pneumonia is safe and decreases length of hospital stay by 2 days.


BACKGROUND
Clinical Trials NCT00273676 [ClinicalTrials.gov].
Oosterheert
Jan Jelrik
JJ
Department of Internal Medicine and Infectious Diseases, University Medical Centre, PO Box 85500, 3508 GA Utrecht, Netherlands.
Bonten
Marc J M
MJ
Schneider
Margriet M E
MM
Buskens
Erik
E
Lammers
Jan-Willem J
JW
Hustinx
Willem M N
WM
Kramer
Mark H H
MH
Prins
Jan M
JM
Slee
Peter H Th J
PH
Kaasjager
Karin
K
Hoepelman
Andy I M
AI
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002511:Cephalosporins / Q000627:therapeutic use*; D019818:Clavulanic Acid / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy*; D004338:Drug Combinations; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D004338:Drug Combinations; D019818:Clavulanic Acid; D000658:Amoxicillin