Cleveland Clinic-Led Study Suggests More Patients with Community-Acquired Pneumonia Could Be Switched from IV to Oral Antibiotics Earlier

Earlier switching was associated with shorter duration of antibiotics and hospital stay

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Findings from a Cleveland Clinic-led study showed for patients with community-acquired pneumonia treated with intravenous (IV) antibiotics, earlier switching to oral antibiotics in clinically stable patients was associated with shorter duration of antibiotics and hospital stay.

The results from this retrospective study, led by Abhishek Deshpande, M.D., Ph.D., a staff physician investigator in the Center for Value-Based Care Research and Michael B. Rothberg, M.D., vice chair of research, Cleveland Clinic Community Care, were recently published in Clinical Infectious Diseases.

Current clinical practice guidelines from the American Thoracic Society/Infectious Diseases Society of America recommend switching from IV to oral antibiotics once patients are clinically stable, which is typically after three days of IV therapy. Early switching in stable patients appears safe but data showed it occurred infrequently in patients with community-acquired pneumonia.

For the study, researchers analyzed data from a national cohort of 378,041 adult patients from 642 hospitals in the U.S. from 2010 to 2015 who were admitted to the hospital with community-acquired pneumonia and initially treated with IV antibiotics.

Of this patient group, approximately six percent were switched early from IV antibiotics to oral antibiotics on or before hospital day three, and 30% were switched before discharge. Early switching to oral antibiotics was associated with shorter length of stay and shorter duration of antibiotic treatment and was not associated with worse outcomes.

Despite the evidence for safety of early switching in stable patients, the study found most patients received IV therapy throughout their hospital stay. The data highlights the opportunity for hospitals to reduce the burden of antibiotics by encouraging clinicians to follow evidence-based recommendations to switch therapy in clinically stable patients with community-acquired pneumonia.

“Community-acquired pneumonia is a leading cause of hospitalizations and antibiotic use,” said Dr. Deshpande. “Optimizing the delivery of antibiotics is crucial, as prolonged exposure can lead to increased antibiotic resistance and healthcare-associated infections. Our research suggests many more patients could be switched earlier without compromising outcomes.”

Over 1 million adults in the United States are hospitalized each year for pneumonia and 50,000 of those die from the disease. The best way to prevent pneumonia is to get vaccinated against bacteria and viruses that commonly cause it.

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