Switch therapy in community-acquired pneumonia.
In patients admitted to the hospital with community-acquired pneumonia, intravenous antimicrobials can be safely switched to oral administration when the patient shows evidence of early clinical improvement. In our institution, patients are switched to oral antibiotics when: (A) cough and respiratory distress are improving, (B) patient is afebrile for at least 8 h, (C) the white blood cell count is returning toward normal, and (D) there is no evidence of abnormal gastrointestinal absorption. Patients with respiratory infections of unknown etiology are switched to an oral antibiotic with the same spectrum of activity as the intravenous empiric antibiotic. Combining our prospective clinical studies, we have patient outcome data for more than 150 patients admitted to the hospital with community-acquired pneumonia, who were treated with switch therapy. The clinical cure rate was 99.3%. The total hospital savings for 1994 based on the 80 patients with community-acquired pneumonia who were treated with switch therapy was $114,080. Discontinuation of intravenous lines will decrease the patient's risk for local cellulitis, abscess formation, septic thrombophlebitis, line sepsis, and endocarditis. The early hospital discharge associated with switch therapy will decrease the patient's risk for other nosocomial infections such as urinary or respiratory tract infections. Switch therapy is associated with a clinical cure rate that is equivalent to conventional therapy. In the area of cost-effective use of antibiotics, switch therapy should be considered as one of the primary options for health care cost containment.