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A Prospective Observational Study of 200 Consecutive Patients With Community-Acquired Pneumonia

Julio A. Ramirez, MD; Sergio Vargas, MD; Gilbert W. Ritter, BSPharm; Michael E. Brier, PhD; Allie Wright, RN; Scott Smith, BSPharm; David Newman, BSPharm; John Burke, MSPharm; Mian Mushtaq, MD; Anna Huang, MD

Arch Intern Med. 1999;159:2449-2454.

Objectives  To determine the proportion of patients who can be treated with early switch to oral antibiotics and early discharge, to evaluate clinical outcome and patient satisfaction for patients treated with early switch and early discharge, and to define the factors that interfere with early discharge for some of the patients who underwent early switch to oral antibiotic therapy.

Design  Prospective study.

Participants  Two hundred consecutive hospitalized patients with community-acquired pneumonia.

Main Outcome Measures  Number of days needed to switch to oral therapy and length of hospital stay. Clinical outcome and satisfaction with care were evaluated for those patients treated with early switch and early discharge.

Results  Early switch to oral antibiotics (within the first 3 days of hospitalization) was performed in 133 patients (67%). Clinical failure was documented in 1 patient. Early switch and early discharge was performed in 88 patients (44%). The mean length of hospital stay for this group was 3.4 days. The most common reason for prolonged hospitalization after the switch to oral antibiotics was the need for diagnostic workup. More than 95% of patients were satisfied with the care they had received.

Conclusions  Using simple clinical and laboratory criteria, a significant proportion of hospitalized patients with community-acquired pneumonia (44%) can be treated with early switch and early discharge. This model did not affect patient outcome, decreased the length of hospitalization, and was associated with a high level of patient satisfaction.

From the Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine and Veterans Affairs Medical Center, Louisville, Ky.

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