Efficacy of early switch from intravenous to oral antimicrobials in patients with aspiration pneumonia: A prospective observational study.
BACKGROUND
Previous reports have documented the efficacy of an early switch from intravenous to oral antimicrobials in community-acquired pneumonia, but not aspiration pneumonia. Therefore, we assessed the feasibility and efficacy of these newly developed criteria for community-acquired pneumonia in patients with aspiration pneumonia.


METHODS
This prospective observational study included consecutive patients admitted with aspiration pneumonia over a 10-month period at St. Luke's International Hospital; we excluded patients that required intensive care. The criteria for an early switch were stability of vital signs (temperature ≤ 38 °C; respiratory rate ≤ 24 breaths/min; pulse rate ≤ 100 beats/min for >24 h) and a successful swallow evaluation (repetitive saliva swallowing test score ≥ 2; modified water swallowing test score ≥ 4). Our primary endpoint was successful completion of antimicrobial treatment 30 days after the switch, without reversion to intravenous antimicrobials. Our anticipated success rate was set as 60-75%, based on a previous study.


RESULTS
Of the 70 patients admitted with aspiration pneumonia, 32 (45.7%) were excluded, and 38 (54.3%) met the inclusion criteria. Of these 38 patients, 29 (76.3%) met the switch criteria. The median duration of hospital stay for the included patients was 16 (5-30) days and 30 (12-68) days, respectively (P=0.03). Among patients who met the switch criteria, 26 (89.7%) completed oral treatment successfully while 3 (10.3%) reverted to intravenous antimicrobials.


CONCLUSIONS
Approximately 75% of patients met the switch criteria; of these, nearly 90% underwent safe conversion to oral therapy. These results demonstrate the efficacy and feasibility of our switch criteria.
Division of Pulmonary Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo City, Tokyo 104-8560, Japan. Electronic address: uni-tky@umin.ac.jp.
Masahiro
M
Uni
Division of Pulmonary Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo City, Tokyo 104-8560, Japan. Electronic address: nina@luke.ac.jp.
Naoki
N
Nishimura
Division of Pulmonary Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo City, Tokyo 104-8560, Japan; Department of Respiratory Medicine and Allergy, Tosei General Hospital, Nishi-oiwake-cho 160, Seto City, Aichi Prefecture, Japan. Electronic address: yaya0630g@gmail.com.
Yasuhiko
Y
Yamano
Division of Pulmonary Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo City, Tokyo 104-8560, Japan. Electronic address: gentahot@hotmail.com.
Genta
G
Ishikawa
Division of Pulmonary Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo City, Tokyo 104-8560, Japan. Electronic address: akitamur@luke.ac.jp.
Atsushi
A
Kitamura
Division of Pulmonary Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo City, Tokyo 104-8560, Japan. Electronic address: yutatomi@luke.ac.jp.
Yutaka
Y
Tomishima
Division of Pulmonary Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo City, Tokyo 104-8560, Japan. Electronic address: jintato@luke.ac.jp.
Torahiko
T
Jinta
Center for Clinical Epidemiology, St. Luke's Life Science Institute, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo City, Tokyo, Japan. Electronic address: otakahas@luke.ac.jp.
Osamu
O
Takahashi
Center for Clinical Epidemiology, St. Luke's Life Science Institute, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo City, Tokyo, Japan. Electronic address: drdeshpande@gmail.com.
Gautam
G
Deshpande
Division of Pulmonary Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo City, Tokyo 104-8560, Japan. Electronic address: chonaoh@luke.ac.jp.
Naohiko
N
Chohnabayashi
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017714:Community-Acquired Infections / Q000188:drug therapy*; D057915:Drug Substitution / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000188:drug therapy*; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
Antimicrobial switch; Aspiration pneumonia; Prospective observational study; Swallowing test; Switch criteria