What factors influence physicians' decisions to switch from intravenous tooral antibiotics for community-acquired pneumonia?

OBJECTIVE: One of the major factors influencing length of stay for patients with community-acquired pneumonia is the timing of conversion from intrave nous to oral antibiotics. We measured physician attitudes and beliefs about the antibiotic switch decision and assessed physician characteristics asso ciated with practice beliefs. DESIGN: Written survey assessing attitudes about the antibiotic conversion decision. SETTING: Seven teaching and non-teaching hospitals in Pittsburgh, Pa. PARTICIPANTS: Three hundred forty-five generalist and specialist attending physicians who manage pneumonia in 7 hospitals. MEASUREMENTS AND RESULTS: Factors rated as "very important" to the antibiot ic conversion decision were: absence of suppurative infection (93%), abilit y to maintain oral intake (79%), respiratory rate at baseline (64%), no pos itive blood cultures (63%), normal temperature (62%). oxygenation at baseli ne (55%). and mental status at baseline (50%). The median thresholds at whi ch physicians believed a typical patient could be converted to oral therapy were: temperature less than or equal to 100 degreesF (37.8 degreesC), resp iratory rate less than or equal to 20 breaths/ minute, heart rate less than or equal to 100 beats/minute, systolic blood pressure greater than or equa l to 100 mm Hg, and room air oxygen saturation greater than or equal to 90% . Fifty-eight percent of physicians felt that "patients should be afebrile for 24 hours before conversion to oral antibiotics," and 19% said, "patient s should receive a standard duration of Intravenous antibiotics." In univar iate analyses, pulmonary and infectious diseases physicians were the most p redisposed towards early conversion to oral antibiotics, and other medical specialists were the least predisposed, with generalists being intermediate (P <.019). In multivariate analyses, practice beliefs were associated with age, Inpatient care activities, attitudes about guidelines. and agreeablen ess on a personality inventory scale. CONCLUSIONS: Physicians believed that patients could be switched to oral an tibiotics once vital signs and mental status had stabilized and oral intake was possible. However, there was considerable variation in several antibio tic practice beliefs. Guidelines and pathways to streamline antibiotic ther apy should include educational strategies to address some of these differen ces In attitudes.