Early switch and early discharge strategies in patients with community-acquired pneumonia - A meta-analysis

Background: The effectiveness of early switch and early discharge strategie s in patients with community-acquired pneumonia remains unknown. Methods: We searched the MEDLINE, HEALTHSTAR, EMBASE, Cochrane Collaboratio n, and Best Evidence databases from January 1, 1980, to March 31, 2000, for community-acquired pneumonia studies that included specific switch criteri a or recommendations to switch on a particular day. Results: From 1794 titles identified, 121 articles were reviewed. We identi fied 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 appli ed early switch criteria also applied separate criteria for early discharge . Six studies applied an early switch and early discharge strategy to an in tervention and control group, and 5 of these provided SD values for LOS. Th e mean change in LOS was not significantly (P=.05) reduced in studies of ea rly switch and early discharge (-1.64 days; 95% confidence inter val, -3.30 to 0.02 days). However, when the 2 studies in which the recommended LOS wa s longer than the control LOS were excluded from the analysis, the mean cha nge in LOS was reduced by 3 days (-3.04 days; 95% confidence interval, -4.9 0 to -1.19 days). Studies did not reveal significant differences in clinica l outcomes between the intervention and control groups. Conclusions: There is considerable variability in early switch from parente ral to oral antibiotic criteria for patients with community-acquired pneumo nia. Early switch and early discharge strategies may significantly and safe ly reduce the mean LOS when the recommended LOS is shorter than the actual LOS.