Early switch to oral antibiotics and early discharge guidelines in the management of community-acquired pneumonia.
OBJECTIVE
The major cost of managing community-acquired pneumonia (CAP) relates to the duration i.v. antibiotic use and length of hospital stay (LOS). Guidelines on early switch to oral antibiotics and early discharge from hospital may help to achieve a unified approach to managing CAP. The aim of this study was to assess the benefits and safety of these guidelines in an Australian respiratory medicine unit.


METHODS
This prospective study included consecutive patients admitted with a diagnosis of CAP over a 6-month period. Early switch to oral antibiotics and early discharge guidelines were implemented one month prior to the evaluation period. Comparison was made to a retrospective control group admitted before the guidelines were implemented. Data collection included patient demographics, clinical and outcome parameters, duration of i.v. antibiotics and LOS. Thirty-day outcomes on patient safety and satisfaction were collected from the prospective group.


RESULTS
One hundred and twenty-five patients in the prospective group were compared to 100 patients in the controls. Baseline characteristics were similar between the comparison groups. Both the mean duration of i.v. antibiotics used (3.38 +/- 0.22 vs. 3.99 +/- 0.28 days, P = 0.03) and LOS (7.62 +/- 0.60 vs. 8.36 +/- 0.55 days, P = 0.04) were significantly shorter in the prospective group. Thirty-day readmission rate was 6% and patient self-reported overall satisfaction was 93.9% in those who were followed up.


CONCLUSIONS
The use of early switch and early discharge guidelines for CAP reduced the duration of i.v. antibiotics and LOS while maintaining high levels of safety and patient satisfaction.
Lee
Richard Wai Wing
RW
Department of Respiratory and Sleep Medicine, The St George Hospital, Kogarah, NSW, Australia.
Lindstrom
Steven Terence
ST
D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D010351:Patient Discharge / Q000592:standards*; D017060:Patient Satisfaction; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000401:mortality; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents