Alpesh N. Amin, MD, MBA; Michael J. Pistoria, DO
Potential Financial Conflicts of Interest: None disclosed.
Amin AN, Pistoria MJ. When to Switch Therapy in Patients with Severe Community-Acquired Pneumonia. Ann Intern Med. 2008;148:625-626. doi: 10.7326/0003-4819-148-8-200804150-00012
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Published: Ann Intern Med. 2008;148(8):625-626.
We thank Dr. Mortensen and colleagues for their recent letter in regards to our Update in Hospital Medicine, which referred to the article by Oosterheert and colleagues (1). We acknowledge that the original trial by Oosterheert and colleagues has potential limitations (some of which were listed by Dr. Mortensen and colleagues), but the concept of switching from intravenous to oral therapy has been documented in the literature as a strategy for care in community-acquired pneumonia. The 2007 combined American Thoracic Society/Infectious Diseases Society of America guidelines (2) for community-acquired pneumonia give a strong recommendation with level II evidence, stating that therapy should be switched from intravenous to oral when patients are hemodynamically stable, are improving clinically, are able to ingest medications, and have a normally functioning gastrointestinal tract. An early switch to oral antibiotics in patients with community-acquired pneumonia allows for early discharge and reduces drug and treatment costs. Previous studies have evaluated only mild-to-moderate disease, whereas the study by Oosterheert and colleagues was the first to look at the potential role for early-switch therapy in patients with severe community-acquired pneumonia. Such studies are needed to determine whether the early-switch strategy works in patients with more severe disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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