Switch Therapy in Adult Patients with Pneumonia

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It has been suggested that in hospitalized patients with pneumonia intravenous antimicrobials can be switched to oral antimicrobials when the patient shows evidence of clinical improvement. At the University of Louisville and the Veterans Affairs Medical Center of Louisville, we have performed several prospective studies to evaluate the clinical outcome of patients treated with short courses of intravenous antimicrobials with an early switch to oral antimicrobials (called “switch therapy”). Patients are switched to oral antimicrobials when (1) cough and respiratory distress are improving, (2) the patient is afebrile for at least 8 hours, (3) the white blood cell count is returning toward normal, and (4) there is no evidence of abnormal gastrointestinal absorption. Combining our prospective clinical studies, we have patient outcome data from more than 150 patients with community-acquired pneumonia and 20 patients with nosocomial pneumonia who were treated with switch therapy. The clinical cure rate was 99%. Since the implementation of switch therapy in 1991, we were able to decrease mortality and length of hospital stay for hospitalized patients with pneumonia in our institution. The mortality rate for patients with pneumonia decreased from 13.3% in 1990 to 8.6% in 1993. The length of hospitalization for patients with pneumonia decreased from 8.2 days in 1990 to 5.8 days in 1993. Based on our clinical experience, we consider switch therapy to be a safe and cost-effective treatment modality for hospitalized patients with pneumonia. Switch therapy may be considered as one of the primary options for containment of health care costs in the management of pneumonia.

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