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Can patients with pneumonia be weaned off IV antibiotics earlier?
Patients hospitalized with pneumonia typically stay on IV antibiotics until they're stable, after about three days, but a new study suggests a different option.
Researchers report that more patients who have community-acquired pneumonia could switch sooner to oral antibiotics. Antibiotics given as pills were also linked with earlier release from the hospital. They were not associated with worse outcomes.
"Community-acquired pneumonia is a leading cause of hospitalizations and antibiotic use," said lead author Dr. Abhishek Deshpande, vice chair of research at Cleveland Clinic Community Care.
"Optimizing the delivery of antibiotics is crucial, as prolonged exposure can lead to increased antibiotic resistance and health care-associated infections," he said in a clinic news release. "Our research suggests many more patients could be switched earlier without compromising outcomes."
For the study, researchers analyzed data from more than 378,000 adult patients treated at 642 U.S. hospitals between 2010 and 2015. They were admitted with community-acquired pneumonia and were initially treated with IV antibiotics.
About 6% of were switched from IV to pill antibiotics on or before their third day in the hospital. About 30% were switched before discharge. Switching over earlier was associated with shorter hospital stays and shorter durations on antibiotics.
The study found that most patients received IV therapy throughout their hospital stay, even though evidence showed it wasn't necessary.
Current guidelines from the American Thoracic Society/Infectious Diseases Society of America recommend switching from IV to oral antibiotics once patients are clinically stable—usually after about three days of IV antibiotics. Switching patients to oral antibiotics is infrequent.
The authors said hospitals could reduce the burden of antibiotics by encouraging clinicians to switch therapy in clinically stable patients with community-acquired pneumonia.
More than 1 million adults in the U.S. are hospitalized each year for pneumonia. More than 50,000 die from the disease.
Getting vaccinated against the bacteria and viruses that typically cause pneumonia is the best prevention.
Study results were recently published in Clinical Infectious Diseases.
More information: Abhishek Deshpande et al, Intravenous to Oral Antibiotic Switch Therapy among Patients Hospitalized with Community-Acquired Pneumonia, Clinical Infectious Diseases (2023). DOI: 10.1093/cid/ciad196
The U.S. National Institutes of Health has more on pneumonia.
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