| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Guest Access | Sign In via User Name/Password
|
|
|
|||||||
Guest Access | Sign In via User Name/Password |
|||||||||
1 From the Department of Medicine, Castle Point (NY) Veterans Affairs Medical Center; and the Department of Pulmonary and Critical Care Medicine, The Mount Sinai School of Medicine, New York
2 From the Department of Pulmonary and Critical Care Medicine, Bronx (NY) Veterans Affairs Medical Center
Study objective: To compare therapeutic outcome and perform a cost-benefit analysis of inpatients with community-acquired pneumonia (CAP) treated with a shortened course of IV antibiotic therapy.
Design: A prospective, randomized, parallel group study with a follow-up period of 28 days.
Setting: Bronx Veterans Affairs Medical Center (VAMC) and the Castle Point VAMC; university-affiliated VAMC general medical wards from September 1993 to March 1995.
Patients: Seventy-two male veterans and 1 female veteran with 75 episodes of CAP defined by a new infiltrate on chest radiograph and either history or physical findings consistent with pneumonia. Study population was 42%(31) black, 33%(24) white, and 25%(18) Hispanic.
Interventions: Patients were randomized (1:1:1) to 1 of 3 treatment groups: group 1 received 2 days of IV and 8 days of oral therapy; group 2 received 5 days of IV and 5 days of oral therapy; and group 3 received 10 days of IV therapy. Antibiotics consisted of cefuroxime, 750 mg every 8 h for the IV course, and cefuroxime axetil, 500 mg every 12 h for the oral therapy.
Measurements and results: No differences were found in the clinical course, cure rates, or resolution of chest radiograph abnormalities among the three groups. A significant difference was found in the length of stay (LOS) among the three groups. The mean±SD LOS was 6±3 days in group 1, 8±2 days in group 2, and 11±1 days in group 3. The shortened LOS could potentially save $95.5 million for the Department of Veterans Affairs and $2.9 billion for the US private sector.
Conclusions: Adult patients hospitalized for CAP who are not severely ill can be successfully treated with an abbreviated (2-day) course of IV antibiotics and then switched to oral therapy. A longer course of IV therapy prolongs hospital stay and cost, without improving the therapeutic cure rate.
Key Words: antibiotic • community-acquired pneumonia • cost • length of stay
Submitted on February 21, 1996
Accepted on May 16, 2007
This article has been cited by other articles:
|
|
 |
|
  M. Woodhead, F. Blasi, S. Ewig, G. Huchon, M. Leven, A. Ortqvist, T. Schaberg, A. Torres, G. van der Heijden, and T. J. M. Verheij Guidelines for the management of adult lower respiratory tract infections Eur. Respir. J., December 1, 2005; 26(6): 1138 - 1180. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. Pass, M. M. Gearhart, and E. J. Young Short-Course Antimicrobial Therapy for the Treatment of Pneumonia Journal of Pharmacy Practice, February 1, 2005; 18(1): 18 - 24. [Abstract] [PDF]
|
|
|
|
 |
|
 N. P. J. Vogtlander, M. E. E. van Kasteren, S. Natsch, B.-J. Kullberg, Y. A. Hekster, and J. W. M. van der Meer Improving the Process of Antibiotic Therapy in Daily Practice: Interventions to Optimize Timing, Dosage Adjustment to Renal Function, and Switch Therapy Arch Intern Med, June 14, 2004; 164(11): 1206 - 1212. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. A. Cunha Empiric Therapy of Community-Acquired Pneumonia: Guidelines for the Perplexed? Chest, May 1, 2004; 125(5): 1913 - 1919. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Bartolome, J. Almirall, J. Morera, G. Pera, V. Ortun, J. Bassa, I. Bolibar, X. Balanzo, A. Verdaguer, and the Maresme Community-Acquired Pneumonia Study Gro A population-based study of the costs of care for community-acquired pneumonia Eur. Respir. J., April 1, 2004; 23(4): 610 - 616. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Fischer, D. H. Solomon, J. M. Teich, and J. Avorn Conversion From Intravenous to Oral Medications: Assessment of a Computerized Intervention for Hospitalized Patients Arch Intern Med, November 24, 2003; 163(21): 2585 - 2589. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. F. Drummond, D. L. Becker, M. Hux, J. V. M. Chancellor, I. Duprat-Lomon, R. Kubin, and P.-P. Sagnier An Economic Evaluation of Sequential IV/po Moxifloxacin Therapy Compared to IV/po Co-amoxiclav With or Without Clarithromycin in the Treatment of Community-Acquired Pneumonia Chest, August 1, 2003; 124(2): 526 - 535. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. A. Halm and A. S. Teirstein Management of Community-Acquired Pneumonia N. Engl. J. Med., December 19, 2002; 347(25): 2039 - 2045. [Full Text] [PDF]
|
|
|
|
|
|
A. Ortqvist Treatment of community-acquired lower respiratory tract infections in adults Eur. Respir. J., July 1, 2002; 20(36_suppl): 40S - 53s. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 BTS Guidelines for the Management of Community Acquired Pneumonia in Adults Thorax, December 1, 2001; 56(90004): iv1 - 64. [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Niederman, L. A. Mandell, A. Anzueto, J. B. Bass, W. A. Broughton, G. D. Campbell, N. Dean, T. File, M. J. Fine, P. A. Gross, et al. Guidelines for the Management of Adults with Community-acquired Pneumonia . Diagnosis, Assessment of Severity, Antimicrobial Therapy, and Prevention Am. J. Respir. Crit. Care Med., June 1, 2001; 163(7): 1730 - 1754. [Full Text] [PDF]
|
|
|
|
|
|
D. C. Rhew, G. S. Tu, J. Ofman, J. M. Henning, M. S. Richards, and S. R. Weingarten Early Switch and Early Discharge Strategies in Patients With Community-Acquired Pneumonia: A Meta-analysis Arch Intern Med, March 12, 2001; 161(5): 722 - 727. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. A. Al-Eidan, J. C. McElnay, M. G. Scott, M. P. Kearney, K. E. U. Troughton, and J. Jenkins Sequential antimicrobial therapy: treatment of severe lower respiratory tract infections in children J. Antimicrob. Chemother., November 1, 1999; 44(5): 709 - 715. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Sevinc, J. M. Prins, R. P. Koopmans, P. N. J. Langendijk, P. M. Bossuyt, J. Dankert, and P. Speelman Early switch from intravenous to oral antibiotics: guidelines and implementation in a large teaching hospital J. Antimicrob. Chemother., April 1, 1999; 43(4): 601 - 606. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. E. Siegel, E. A. Halm, M. J. Fine, and D. E. Singer Time to Clinical Stability for Patients With Community-Acquired Pneumonia JAMA, January 20, 1999; 281(3): 231 - 232. [Full Text] [PDF]
|
|
|
|
|
|
E. A. Halm, M. J. Fine, T. J. Marrie, C. M. Coley, W. N. Kapoor, D. S. Obrosky, and D. E. Singer Time to Clinical Stability in Patients Hospitalized With Community-Acquired Pneumonia: Implications for Practice Guidelines JAMA, May 13, 1998; 279(18): 1452 - 1457. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 SWITCHING FROM IV TO ORAL THERAPY FOR PNEUMONIA Journal Watch (General), November 1, 1996; 1996(1101): 3 - 3. [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
