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Early Switch and Early Discharge Strategies in Patients With Community-Acquired Pneumonia
A Meta-analysis
David C. Rhew, MD;
George S. Tu, MD;
Joshua Ofman, MD, MSHS;
James M. Henning, MS;
Margaret S. Richards, PhD;
Scott R. Weingarten, MD, MPH
Arch Intern Med. 2001;161:722-727.
Background The effectiveness of early switch and early discharge strategies in
patients with community-acquired pneumonia remains unknown.
Methods We searched the MEDLINE, HEALTHSTAR, EMBASE, Cochrane Collaboration,
and Best Evidence databases from January 1, 1980, to March 31, 2000, for community-acquired
pneumonia studies that included specific switch criteria or recommendations
to switch on a particular day.
Results From 1794 titles identified, 121 articles were reviewed. We identified
10 prospective, interventional, community-acquired pneumonia–specific
studies that evaluated length of stay (LOS). Nine studies applied an early
switch from parenteral to oral antibiotic criteria. Six different criteria
for switching were applied in the 9 studies. Five of the studies that applied
early switch criteria also applied separate criteria for early discharge.
Six studies applied an early switch and early discharge strategy to an intervention
and control group, and 5 of these provided SD values for LOS. The mean change
in LOS was not significantly (P = .05) reduced in
studies of early switch and early discharge (-1.64 days; 95% confidence
interval, -3.30 to 0.02 days). However, when the 2 studies in which
the recommended LOS was longer than the control LOS were excluded from the
analysis, the mean change in LOS was reduced by 3 days (-3.04 days;
95% confidence interval, -4.90 to -1.19 days). Studies did not
reveal significant differences in clinical outcomes between the intervention
and control groups.
Conclusions There is considerable variability in early switch from parenteral to
oral antibiotic criteria for patients with community-acquired pneumonia. Early
switch and early discharge strategies may significantly and safely reduce
the mean LOS when the recommended LOS is shorter than the actual LOS.
From Zynx Health Inc, Cedars-Sinai Departments of Medicine and Health
Services Research, Beverly Hills, Calif (Drs Rhew, Tu, Ofman, and Weingarten);
the University of California, Los Angeles, UCLA School of Medicine (Drs Tu,
Ofman, and Weingarten); West Los Angeles Veterans Affairs Medical Center,
Los Angeles, Calif (Dr Rhew); and TAP Pharmaceutical Products Inc, Lake Forest,
Ill (Mr Henning and Dr Richards).
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