BMJ  2006;333:1193 (9 December), doi:10.1136/bmj.38993.560984.BE (published 7 November 2006)

Research

Effectiveness of early switch from intravenous to oral antibiotics in severe community acquired pneumonia: multicentre randomised trial

Jan Jelrik Oosterheert, research associate1, Marc J M Bonten, professor of infectious diseases1, Margriet M E Schneider, infectiologist1, Erik Buskens, associate professor of epidemiology2, Jan-Willem J Lammers, professor of pulmonology3, Willem M N Hustinx, infectiologist4, Mark H H Kramer, internist/haematologist5, Jan M Prins, infectiologist6, Peter H Th J Slee, internist7, Karin Kaasjager, internist8, Andy I M Hoepelman, professor of medicine1

1 Department of Internal Medicine and Infectious Diseases, University Medical Centre, PO Box 85500, 3508 GA Utrecht, Netherlands, 2 Julius Centre for Health Sciences and Primary Care, University Medical Centre, 3 Department of Pulmonology, University Medical Centre, 4 Department of Internal Medicine, Diakonessenhuis, Utrecht, 5 Department of Internal Medicine, Meander Medical Centre, Amersfoort, Netherlands, 6 Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and Aids, Academic Medical Centre, Amsterdam, Netherlands, 7 Department of Internal Medicine, St Antonius Hospital, Nieuwegein, Netherlands, 8 Department of Internal Medicine, Rijnstate Hospital, Arnhem, Netherlands

Correspondence to: A I M Hoepelman i.m.hoepelman{at}umcutrecht.nl

Objectives To compare the effectiveness of an early switch to oral antibiotics with the standard 7 day course of intravenous antibiotics in severe community acquired pneumonia.

Design Multicentre randomised controlled trial.

Setting Five teaching hospitals and 2 university medical centres in the Netherlands.

Participants 302 patients in non-intensive care wards with severe community acquired pneumonia. 265 patients fulfilled the study requirements.

Intervention Three days of treatment with intravenous antibiotics followed, when clinically stable, by oral antibiotics or by 7 days of intravenous antibiotics.

Main outcome measures Clinical cure and length of hospital stay.

Results 302 patients were randomised (mean age 69.5 (standard deviation 14.0), mean pneumonia severity score 112.7 (26.0)). 37 patients were excluded from analysis because of early dropout before day 3, leaving 265 patients for intention to treat analysis. Mortality at day 28 was 4% in the intervention group and 6% in the control group (mean difference 2%, 95% confidence interval –3% to 8%). Clinical cure was 83% in the intervention group and 85% in the control group (2%, –7% to 10%). Duration of intravenous treatment and length of hospital stay were reduced in the intervention group, with mean differences of 3.4 days (3.6 (1.5) v 7.0 (2.0) days; 2.8 to 3.9) and 1.9 days (9.6 (5.0) v 11.5 (4.9) days; 0.6 to 3.2), respectively.

Conclusions Early switch from intravenous to oral antibiotics in patients with severe community acquired pneumonia is safe and decreases length of hospital stay by 2 days.

Trial registration Clinical Trials NCT00273676 [ClinicalTrials.gov] .


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Articles

Recent changes in the management of community acquired pneumonia in adults
Hannah J Durrington and Charlotte Summers
BMJ 2008 336: 1429-1433. [Extract] [Full Text] [PDF]

Early use of oral antibiotics in severe community acquired pneumonia
BMJ 2006 333: 0. [Full Text] [PDF]

US Highlights
Douglas Kamerow
BMJ 2006 333: 0. [Extract] [Full Text]

Severe community acquired pneumonia
Graham D Mills and Richard Laing
BMJ 2006 333: 1181-1182. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

  • Barlow, G. D., on behalf of the BSAC Council, (2009). Swine flu and antibiotics. J Antimicrob Chemother 64: 889-894 [Abstract] [Full text]  
  • Mertz, D., Koller, M., Haller, P., Lampert, M. L., Plagge, H., Hug, B., Koch, G., Battegay, M., Fluckiger, U., Bassetti, S. (2009). Outcomes of early switching from intravenous to oral antibiotics on medical wards. J Antimicrob Chemother 64: 188-199 [Abstract] [Full text]  
  • Bruns, A. H. W., Oosterheert, J. J., Hak, E., Hoepelman, A. I. M. (2008). Usefulness of consecutive C-reactive protein measurements in follow-up of severe community-acquired pneumonia. Eur Respir J 32: 726-732 [Abstract] [Full text]  
  • Durrington, H. J, Summers, C. (2008). Recent changes in the management of community acquired pneumonia in adults. BMJ 336: 1429-1433 [Full text]  
  • Mortensen, E. M., Restrepo, M. I., Anzueto, A. (2008). When to Switch Therapy in Patients with Severe Community-Acquired Pneumonia. ANN INTERN MED 148: 625-625 [Full text]  
  • Amin, A. N., Pistoria, M. J. (2008). When to Switch Therapy in Patients with Severe Community-Acquired Pneumonia. ANN INTERN MED 148: 625-626 [Full text]  
  • Amin, A. N., Pistoria, M. J. (2007). Update in Hospital Medicine. ANN INTERN MED 147: 628-632 [Full text]  
  • (2007). When to Switch from IV to Oral Antibiotics in Severe Community-Acquired Pneumonia. JWatch General 2007: 5-5 [Full text]  
  • (2007). Early Switch to Oral Antibiotics in CAP. JWatch Infect. Diseases 2007: 3-3 [Full text]  
  • Mills, G. D, Laing, R. (2006). Severe community acquired pneumonia. BMJ 333: 1181-1182 [Full text]  

Rapid Responses:

Read all Rapid Responses

No" One size fits all" when it comes to pnemonia treatmnet
Mohamed S. Noshi,MD,FACP
bmj.com, 9 Nov 2006 [Full text]
Same effectiveness in children?
Patrícia GM Bezerra
bmj.com, 10 Nov 2006 [Full text]
Risk stratification of Community acquired pneumonia
Kaushik sanyal
bmj.com, 11 Nov 2006 [Full text]
Antibiotics In pneumonia
Sameer Chadha, et al.
bmj.com, 10 Dec 2006 [Full text]
A straw man?
Rowan H Harwood
bmj.com, 11 Dec 2006 [Full text]
Antibiotics and Severe Pneumonia
Michael E Reschen
bmj.com, 11 Dec 2006 [Full text]
Benefits Wider than Early Discharge
Alexandra L Thomson-Moore
bmj.com, 12 Dec 2006 [Full text]
Shuffled data.
Christopher S. Musgrove
bmj.com, 25 May 2007 [Full text]
Access jobs at BMJ Careers
Whats new online at Student BMJ