Early Switch to Oral Treatment in Patients with Moderate to Severe Community-Acquired Pneumonia A Meta-Analysis

Background: Early switch to oral antibacterials is recommended for the treatment of hospitalized patients with community-acquired pneumonia (CAP). However, its efficacy and safety in patients with more severe forms of CAP have not been well established. Objective: To evaluate early switch to oral treatment in hospitalized patients with moderate to severe CAP. Methods: Two reviewers independently extracted data from relevant randomized controlled trials (RCTs) with the same total duration of antibacterial treatment in the compared groups (early switch from intravenous to oral and conventional intravenous treatment for the whole duration of therapy). Results: Six RCTs including 1219 patients fulfilled the criteria for inclusion in the meta-analysis. Treatment success was not different between early switch to oral treatment and intravenous only treatment groups in both intention to treat (odds ratio [OR] 0.76; 95% CI 0.36, 1.59) and clinically evaluable patients (OR 0.92; 95% CI 0.61, 1.39). Mortality and recurrence of CAP were not different (OR 0.81; 95% CI 0.49, 1.33 and OR 1.81; 95% CI 0.70, 4.72, respectively), while duration of hospitalization was shorter (weight mean difference -3.34; 95% CI -4.42, -2.25) and drug-related adverse events were fewer in the early switch group (OR 0.65; 95% CI 0.48, 0.89). Findings were similar in patients with severe CAP. Conclusions: Early conversion to oral antibacterials seems to be as effective as continuous intravenous treatment in patients with moderate to severe CAP and results in substantial reduction in duration of hospitalization.