Source: Annual Congress 2001 - Community-acquired pneumonia: from diagnosis to discharge
Disease area: Respiratory infections

Abstract

Introduction: Many studies have been performed to determine when to switch to oral antibiotic therapy. Important limitations in some of these studies are the exclusion of patients with [dsquote]atypical[dsquote] CAP and the absence of describing the severity of CAP. The aim of our study was to determine whether a simple approach for switch therapy could be applied in patients with CAP.
Methods: A prospective study was performed in which switch therapy was applied in patients who were afebrile for 72 hours and who showed improvement of respiratory symptoms. Exclusion criteria were: presence of an immunosuppressive state, malignancy, nosocomial pneumonia, postobstructive pneumonia, admission to Intensive Care Unit, empyema, lung abscess, abnormal gastrointestinal absorption. Patients were randomized in two groups, one group received pathogen-directed therapy, the second group received empirical antibiotic therapy according to the ATS guidelines. We also compared severity of CAP according to the pneumonia severity index (PSI) of Fine with day of switch, length of stay (LOS) and median C-reactive protein (CRP) results on day one and day seven.
Results:

PSI	class 1	class 2	class 3	class 4	class 5	Total	p-value
No. patients	21	52	53	73	11	210
Failure(%)	1 (5)	1 (2)	1 (2)	4 (5)	1 (10)	8 (4)	0,664
Day of switch, median (range)	4 (0-7)	5 (2-8)	5 (2-8)	5 (3-16)	6 (4-7)	5 (0-16)	0,006
LOS (days), median (range)	6 (3-17)	8 (4-22)	10 (5-23)	12 (4-64)	17 (8-63)	10 (3-64)	<0,001
CRP-day 1, median (range)	140 (10-323)	112 (4-577)	143 (4-630)	132 (4-519)	197 (34-469)	134 (4-630)	0,77
CRP-day7, median (range)	17 (2-146)	18 (3-104)	29 (2-181)	33 (4-152)	69 (9-199)	27 (2-199)	0,007

Discussion: Failure was seen in eight patients, four patients received a pathogen-directed treatment and four of them received empirical treatment. These results, supported by a decrease in CRP after switch, showed that this simple method for switch therapy can be applied in low and high risk patients with CAP.

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Citations should be made in the following way:
M. M. van der Eerden, C. S. De Graaff, F. Vlaspolder, W. Bronsveld, W. G. Boersma (Alkmaar, The Netherlands). A simple method for determining the time of conversion to oral antibiotic therapy in community-acquired pneumonia (CAP). Eur Respir J 2001; 16: Suppl. 31, 3395

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