Early switch from intravenous to oral antibiotics in hospitalized patientswith bacteremic community-acquired Streptococcus pneumoniae pneumonia

Background: The identification of Streptococcus pneumoniae bacteremia in ho spitalized patients with community-acquired pneumonia is considered by some investigators to be an exclusion criterion for early switch from intraveno us to oral therapy. Objective: To determine whether the switch from intravenous to oral therapy in such patients, once the bx; 1 patient reaches clinical stability, is as sociated with poor clinical outcome. Methods The medical records of 400 patients with community-acquired pneumon ia hospitalized at the Veterans Affairs Medical Center of Louisville (Louis ville, Ky) were reviewed to identify patients with bacteremic S pneumoniae. Four criteria were used to define when a patient reached clinical stabilit y and should be considered a candidate for switch therapy: (1) cough and sh ortness of breath are improving, (2) patient is afebrile for at least 8 hou rs, (3) white blood cell count is normalizing, and (4) oral intake and gast rointestinal tract absorption are adequate. Results: A total of 36 bacteremic patients were identified. No clinical fai lures occurred in 18 patients who reached clinical stability and were switc hed to oral therapy or in 7 patients who reached clinical stability and con tinued intravenous therapy. Clinical failures (5 deaths) occurred in the gr oup of 11 patients who did not reach clinical stability. Conclusion: Once a hospitalized patient with community-acquired pneumonia r eaches clinical stability, it is safe to switch from intravenous to oral an tibiotics even if bacteremia caused by S pneumoniae was initially documente d.