Clinical stability and switch therapy in hospitalised patients with community-acquired pneumonia: are we there yet?

Abstract

In this issue of the European Respiratory Journal , Engel et al. [1] studied barriers for early switch therapy in hospitalised patients with community-acquired pneumonia (CAP). The authors reference our initial work in the field of switch therapy, published in 1995 in Archives of Internal Medicine [2]. In hospitalised patients with CAP, the standard of practice before 1995 was to use intravenous antibiotics for the full duration of therapy. During our initial study, we obtained consent from patients to see if they were willing to participate in a trial using oral antibiotics once they reached clinical stability. Our Institutional Review Board requested a full evaluation of the initial 10 patients enrolled in the trial to be sure that a switch to oral antibiotics would not be associated with poor clinical outcomes. During the development of the protocol we decided to define clinical stability using two symptoms of CAP (cough and sputum production) and two signs of systemic response (fever and leukocytosis). Patients were defined as …