Switch from IV to oral antibiotics associated with shorter hospital stays, treatment length
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Key takeaways:
- Fewer than 6% were “early switchers,” despite this being associated with a shorter duration of antibiotics and hospital stay.
- Only 30.7% of patients were switched to oral antibiotics before hospital discharge.
Researchers found that pneumonia patients who were switched early from IV to oral antibiotics had shorter hospital stays and fewer days on antibiotics.
“The Infectious Diseases Society of America (IDSA) guidelines advocate for a prompt transition from intravenous (IV) to oral antibiotics in pneumonia patients as soon as they are clinically stable. However, there were no large-scale studies evaluating the switching practices (from IV to oral antibiotics) across U.S. hospitals,” Abhishek Deshpande, MD, PhD, assistant professor of medicine in the department of infectious diseases at the Center for Value-Based Care Research at Cleveland Clinic, told Healio.
“A comprehensive understanding of these practices is necessary to validate the guideline recommendations and generate evidence to drive duality improvement efforts,” Deshpande said.
Deshpande and colleagues conducted a retrospective cohort study of adults admitted with community-acquired pneumonia (CAP) who were initially treated with IV antibiotics at any of 642 U.S. hospitals between 2010 and 2015. Patients who were treated with a discontinuation of IV antibiotics and initiated oral antibiotics without interruption by their third day in the hospital were considered “early switchers.”
According to the study, the researchers compared length of stay (LOS), in-hospital 14-day mortality, late deterioration or ICU transfer and hospital costs between early switchers and other patients.
In total, 21,784 of 378,041 patients with CAP (5.8%) were considered early switchers, although 116,118 (30.7%) were switched to oral antibiotics before discharge.
Overall, the study showed that early switchers had fewer days on IV antibiotics (risk-adjusted ratio of means = 0.44; 95% CI, 0.44-0.44), shorter duration of inpatient antibiotic treatment (risk-adjusted ratio of means = 0.88; 95% CI, 0.87-0.88), shorter LOS (risk-adjusted ratio of means = 0.85; 95% CI, 0.85-0.86), and an overall lower hospitalization cost (risk-adjusted ratio of means = 0.84; 95% CI, 0.84-0.84).
The study also revealed that there were no significant differences in 14-day in-hospital mortality (risk-adjusted ratio of means = 0.65; 95% CI, 0.55-0.77) or late ICU admission (risk-adjusted ratio of means = 0.66; 95% CI, 0.66; 95% CI, 0.58-0.75) between early switchers and other patients.
“Hospitals must encourage clinicians to adhere to evidence-based recommendations for switching therapy in clinically stable pneumonia patients,” Deshpande said. “Implementing such practices can lead to shorter hospital stays and reduced antibiotic use without compromising patient outcomes.”
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