Early switch and early discharge strategies in patients with community-acquired pneumonia: a meta-analysis.

BACKGROUND The effectiveness of early switch and early discharge strategies in patients with community-acquired pneumonia remains unknown. METHODS We searched the MEDLINE, HEALTHSTAR, EMBASE, Cochrane Collaboration, and Best Evidence databases from January 1, 1980, to March 31, 2000, for community-acquired pneumonia studies that included specific switch criteria or recommendations to switch on a particular day. RESULTS From 1794 titles identified, 121 articles were reviewed. We identified 10 prospective, interventional, community-acquired pneumonia-specific studies that evaluated length of stay (LOS). Nine studies applied an early switch from parenteral to oral antibiotic criteria. Six different criteria for switching were applied in the 9 studies. Five of the studies that applied early switch criteria also applied separate criteria for early discharge. Six studies applied an early switch and early discharge strategy to an intervention and control group, and 5 of these provided SD values for LOS. The mean change in LOS was not significantly (P =.05) reduced in studies of early switch and early discharge (-1.64 days; 95% confidence interval, -3.30 to 0.02 days). However, when the 2 studies in which the recommended LOS was longer than the control LOS were excluded from the analysis, the mean change in LOS was reduced by 3 days (-3.04 days; 95% confidence interval, -4.90 to -1.19 days). Studies did not reveal significant differences in clinical outcomes between the intervention and control groups. CONCLUSIONS There is considerable variability in early switch from parenteral to oral antibiotic criteria for patients with community-acquired pneumonia. Early switch and early discharge strategies may significantly and safely reduce the mean LOS when the recommended LOS is shorter than the actual LOS.