ORAL VERSUS INTRAVENOUS ANTIBIOTICS FOR COMMUNITY-ACQUIRED LOWER RESPIRATORY-TRACT INFECTION IN A GENERAL-HOSPITAL - OPEN, RANDOMIZED CONTROLLED TRIAL

Objective-To see whether there is a difference in outcome between pati ents treated with oral and intravenous antibiotics for lower respirato ry tract infection. Design-Open controlled trial in patients admitted consecutively and randomised to treatment with either oral co-amoxicla v, intravenous followed by oral co-amoxiclav, or intravenous followed by oral cephalosporins. Setting-Large general hospital in Dublin. Pati ents-541 patients admitted for lower respiratory tract infection durin g one year. Patients represented 87% of admissions with the diagnosis and excluded those who were immunocompromised and patients with severe Life threatening infection. Main outcome measures-Cure, partial cure, extended antibiotic treatment, change of antibiotic, death, and cost and duration of hospital stay. Results-There were no significant diffe rences between the groups in clinical outcome or mortality (6%). Howev er, patients randomised to oral co-amoxiclav had a significantly short er hospital stay than the two groups given intravenous antibiotic (med ian 6 v 7 and 9 days respectively). In addition, oral antibiotics were cheaper, easier to administer, and if used routinely in the 800 or so patients admitted annually would lead to savings of around pound 176 000 a year. Conclusions-Oral antibiotics in community acquired lower r espiratory tract infection are at least as efficacious as intravenous therapy. Their use reduces labour and equipment costs and may lead to earlier discharge from hospital.