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Early Switch From Intravenous to Oral Antibiotics in Hospitalized Patients With Bacteremic Community-Acquired Streptococcus pneumoniae Pneumonia
Julio A. Ramirez, MD;
Jose Bordon, MD
Arch Intern Med. 2001;161:848-850.
Background The identification of Streptococcus pneumoniae
bacteremia in hospitalized patients with community-acquired pneumonia is considered
by some investigators to be an exclusion criterion for early switch from intravenous
to oral therapy.
Objective To determine whether the switch from intravenous to oral therapy in
such patients, once the patient reaches clinical stability, is associated
with poor clinical outcome.
Methods The medical records of 400 patients with community-acquired pneumonia
hospitalized at the Veterans Affairs Medical Center of Louisville (Louisville,
Ky) were reviewed to identify patients with bacteremic S pneumoniae. Four criteria were used to define when a patient reached
clinical stability and should be considered a candidate for switch therapy:
(1) cough and shortness of breath are improving, (2) patient is afebrile for
at least 8 hours, (3) white blood cell count is normalizing, and (4) oral
intake and gastrointestinal tract absorption are adequate.
Results A total of 36 bacteremic patients were identified. No clinical failures
occurred in 18 patients who reached clinical stability and were switched to
oral therapy or in 7 patients who reached clinical stability and continued
intravenous therapy. Clinical failures (5 deaths) occurred in the group of
11 patients who did not reach clinical stability.
Conclusion Once a hospitalized patient with community-acquired pneumonia reaches
clinical stability, it is safe to switch from intravenous to oral antibiotics
even if bacteremia caused by S pneumoniae was initially
documented.
From the Division of Infectious Diseases, Department of Medicine, University
of Louisville School of Medicine, Louisville, Ky.
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