Managing Antiinfective Therapy of Community-Acquired Pneumonia in the Hospital Setting: Focus on Swi
Managing Antiinfective Therapy of Community-Acquired Pneumonia in the Hospital Setting: Focus on Switch Therapy
Targeting patients for early switch from intravenous to oral antibiotic therapy and early hospital discharge is an important strategy in the management of community-acquired pneumonia (CAP). This strategy can reduce costs due to drug administration and length of hospital stay. We show that switch therapy can be implemented safely when four criteria are met: cough and respiratory distress improve, fever abates for at least 8 hours, white blood cell count is returning to normal, and patient can take drugs orally. In prospective clinical studies conducted at our institution, the clinical cure rate with switch therapy was 99%, and mean length of hospital stay was reduced by more than 2 days. Early switch, coupled with hospital discharge, may be possible in nearly half of all CAP patients. Universal use of switch therapy in the United States could result in the total reduction of about 440,000 hospital days annually and an overall savings of $400 million.
Community-acquired pneumonia (CAP) remains a serious cause of morbidity and mortality, particularly in the elderly and in patients with comorbid conditions. Traditionally, therapy for CAP has relied on intravenous antimicrobials until the disease is greatly improved or resolved; then intravenous therapy is discontinued and the patient is discharged from the hospital. However, examination of the natural history of a treated infection suggests that prolonged intravenous therapy and hospital-ization may be unnecessary. Typically, anti-microbial therapy halts clinical deterioration, and improvement becomes evident within 24-72 hours. Further, the recovery phase of most patients with infections involves three stages: clinically unstable, early improvement, and definite improvement (Figure 1). These observations led to a hypothesis that most patients may not require intravenous therapy throughout the entire course of treatment and, further, a switch from intravenous to oral therapy might facilitate early discharge.
(Enlarge Image)
The recovery phase of most patients with infections involves three stages: clinically unstable, early improvement, and definite clinical improvement. Modified from reference 1.
Hospitalization is a primary driver of costs in CAP; therefore, evaluating this theory was deemed important. The goal was to maintain or improve patient outcomes while decreasing costs, particularly those related to hospitalization and antimicrobial therapy. When switch-therapy studies were initiated at the Louisville (Kentucky) Veterans Affairs Medical Center (VAMC), the average length of hospitalization for patients with CAP was 6 days, and the most frequently used initial empiric therapy was a third-generation cephalosporin.
Targeting patients for early switch from intravenous to oral antibiotic therapy and early hospital discharge is an important strategy in the management of community-acquired pneumonia (CAP). This strategy can reduce costs due to drug administration and length of hospital stay. We show that switch therapy can be implemented safely when four criteria are met: cough and respiratory distress improve, fever abates for at least 8 hours, white blood cell count is returning to normal, and patient can take drugs orally. In prospective clinical studies conducted at our institution, the clinical cure rate with switch therapy was 99%, and mean length of hospital stay was reduced by more than 2 days. Early switch, coupled with hospital discharge, may be possible in nearly half of all CAP patients. Universal use of switch therapy in the United States could result in the total reduction of about 440,000 hospital days annually and an overall savings of $400 million.
Community-acquired pneumonia (CAP) remains a serious cause of morbidity and mortality, particularly in the elderly and in patients with comorbid conditions. Traditionally, therapy for CAP has relied on intravenous antimicrobials until the disease is greatly improved or resolved; then intravenous therapy is discontinued and the patient is discharged from the hospital. However, examination of the natural history of a treated infection suggests that prolonged intravenous therapy and hospital-ization may be unnecessary. Typically, anti-microbial therapy halts clinical deterioration, and improvement becomes evident within 24-72 hours. Further, the recovery phase of most patients with infections involves three stages: clinically unstable, early improvement, and definite improvement (Figure 1). These observations led to a hypothesis that most patients may not require intravenous therapy throughout the entire course of treatment and, further, a switch from intravenous to oral therapy might facilitate early discharge.
(Enlarge Image)
The recovery phase of most patients with infections involves three stages: clinically unstable, early improvement, and definite clinical improvement. Modified from reference 1.
Hospitalization is a primary driver of costs in CAP; therefore, evaluating this theory was deemed important. The goal was to maintain or improve patient outcomes while decreasing costs, particularly those related to hospitalization and antimicrobial therapy. When switch-therapy studies were initiated at the Louisville (Kentucky) Veterans Affairs Medical Center (VAMC), the average length of hospitalization for patients with CAP was 6 days, and the most frequently used initial empiric therapy was a third-generation cephalosporin.