EARLY TRANSITION TO ORAL ANTIBIOTIC-THERAPY FOR COMMUNITY-ACQUIRED PNEUMONIA - DURATION OF THERAPY, CLINICAL OUTCOMES, AND COST-ANALYSIS

Our objective was to compare therapeutic outcome and analyse cost-bene fit of a 'conventional' (7-day course of i.v. antibiotic therapy) vs. an abbreviated (2-day i.v. antibiotic course followed by 'switch' to o ral antibiotics) therapy for in-patients with community-acquired pneum onia (CAP). We used a multicenter prospective, randomized, parallel gr oup with a 28 day follow-up, at the University-based teaching hospital s: The Medical Center of Louisiana in New Orleans, LA and hospitals li sted in the acknowledgement. Ninety-five patients were randomized to r eceive either a 'conventional' course of intravenous antibiotic therap y with cefamandole Ig i.v. every 6 h for 7 days (n=37), or an abbrevia ted course of intravenous therapy with cefamandole (1 g i.v. every 6 h for 2 days) followed by oral therapy with cefaclor (500 mg every 8 h for 5 days). No difference was found in the clinical courses, cure rat es, survival or the resolution of the chest radiograph abnormalities a mong the two groups. The mean duration of therapy (6.88 days for the c onventional group compared to 7.30 days for the early oral therapy gro up) and the frequencies of overall symptomatic improvement (97% vs. 95 %, respectively) were similar in both groups. Patients who received ea rly oral therapy had shorter hospital stays (7.3 vs. 9.71 days, P=0.01 ), and a lower total cost of care ($2953 vs. $5002, P<0.05). It was co ncluded that early transition to an oral antibiotic after an abbreviat ed course of intravenous therapy in CAP is substantially less expensiv e and has comparable efficacy to conventional intravenous therapy. Alt ering physicians' customary management of hospitalized patients with C AP can reduce costs with no appreciable additional risk of adverse pat ient outcome.