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Efficacy of exclusively oral antibiotic therapy in patients hospitalized with nonsevere community-acquired pneumonia: a retrospective study and meta-analysis.
Am J Med. 2004 Mar 15; 116(6):385-93.AJ

Abstract

PURPOSE

To assess the efficacy of oral antibiotics in patients hospitalized with community-acquired pneumonia and to identify factors precluding oral therapy.

METHODS

In a meta-analysis, we compared inpatient oral and parenteral therapy in community-acquired pneumonia. Studies were reviewed independently and rated by two reviewers, and results were summarized. We also performed a retrospective cohort study of hospitalized patients with community-acquired pneumonia and compared outcomes in patients treated with oral versus parenteral therapy.

RESULTS

For the meta-analysis, we identified seven studies involving 1366 patients. Study exclusions included severe pneumonia or impaired oral absorption. There was no significant difference in the relative risk of mortality at the end of treatment or at follow-up. Mean length of hospital stay was shorter (6.1 days vs. 7.8 days) in patients taking oral antibiotics than in those taking the parental form. In the retrospective cohort, 18% (124/698) of patients received oral-only therapy; these patients were younger (median age, 75 vs. 78 years, P = 0.01) and had lower mean pneumonia severity index scores (101 vs. 119, P <0.0001) than those who received parenteral therapy. In multivariable models, oral-only patients had a median length of stay that was 1.3 days shorter (95% CI: 0.4% to 2.2% days; P = 0.008) and a median antibiotic cost that was 56 dollars lower (95% CI: 53 dollars to 58 dollars; P <0.0001) than that of patients in the parenteral group, but mortality was similar.

CONCLUSION

Although prospective data are limited, oral antibiotics in certain hospitalized patients with community-acquired pneumonia are effective. More data are needed to identify appropriate candidates for exclusively oral antibiotic therapy.

Authors+Show Affiliations

Joint Division of Respirology, Department of Medicine, University Health Network, and Mount Sinai Hospital, University of Toronto, Toronto, Canada. ted.marras@utoronto.caNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Multicenter Study

Language

eng

PubMed ID

15006587

Citation

Marras, Theodore K., et al. "Efficacy of Exclusively Oral Antibiotic Therapy in Patients Hospitalized With Nonsevere Community-acquired Pneumonia: a Retrospective Study and Meta-analysis." The American Journal of Medicine, vol. 116, no. 6, 2004, pp. 385-93.
Marras TK, Nopmaneejumruslers C, Chan CK. Efficacy of exclusively oral antibiotic therapy in patients hospitalized with nonsevere community-acquired pneumonia: a retrospective study and meta-analysis. Am J Med. 2004;116(6):385-93.
Marras, T. K., Nopmaneejumruslers, C., & Chan, C. K. (2004). Efficacy of exclusively oral antibiotic therapy in patients hospitalized with nonsevere community-acquired pneumonia: a retrospective study and meta-analysis. The American Journal of Medicine, 116(6), 385-93.
Marras TK, Nopmaneejumruslers C, Chan CK. Efficacy of Exclusively Oral Antibiotic Therapy in Patients Hospitalized With Nonsevere Community-acquired Pneumonia: a Retrospective Study and Meta-analysis. Am J Med. 2004 Mar 15;116(6):385-93. PubMed PMID: 15006587.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of exclusively oral antibiotic therapy in patients hospitalized with nonsevere community-acquired pneumonia: a retrospective study and meta-analysis. AU - Marras,Theodore K, AU - Nopmaneejumruslers,Cherdchai, AU - Chan,Charles K N, PY - 2002/12/20/received PY - 2003/11/04/revised PY - 2003/11/04/accepted PY - 2004/3/10/pubmed PY - 2004/4/2/medline PY - 2004/3/10/entrez SP - 385 EP - 93 JF - The American journal of medicine JO - Am J Med VL - 116 IS - 6 N2 - PURPOSE: To assess the efficacy of oral antibiotics in patients hospitalized with community-acquired pneumonia and to identify factors precluding oral therapy. METHODS: In a meta-analysis, we compared inpatient oral and parenteral therapy in community-acquired pneumonia. Studies were reviewed independently and rated by two reviewers, and results were summarized. We also performed a retrospective cohort study of hospitalized patients with community-acquired pneumonia and compared outcomes in patients treated with oral versus parenteral therapy. RESULTS: For the meta-analysis, we identified seven studies involving 1366 patients. Study exclusions included severe pneumonia or impaired oral absorption. There was no significant difference in the relative risk of mortality at the end of treatment or at follow-up. Mean length of hospital stay was shorter (6.1 days vs. 7.8 days) in patients taking oral antibiotics than in those taking the parental form. In the retrospective cohort, 18% (124/698) of patients received oral-only therapy; these patients were younger (median age, 75 vs. 78 years, P = 0.01) and had lower mean pneumonia severity index scores (101 vs. 119, P <0.0001) than those who received parenteral therapy. In multivariable models, oral-only patients had a median length of stay that was 1.3 days shorter (95% CI: 0.4% to 2.2% days; P = 0.008) and a median antibiotic cost that was 56 dollars lower (95% CI: 53 dollars to 58 dollars; P <0.0001) than that of patients in the parenteral group, but mortality was similar. CONCLUSION: Although prospective data are limited, oral antibiotics in certain hospitalized patients with community-acquired pneumonia are effective. More data are needed to identify appropriate candidates for exclusively oral antibiotic therapy. SN - 0002-9343 UR - https://www.unboundmedicine.com/medline/citation/15006587/Efficacy_of_exclusively_oral_antibiotic_therapy_in_patients_hospitalized_with_nonsevere_community_acquired_pneumonia:_a_retrospective_study_and_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002934303007307 DB - PRIME DP - Unbound Medicine ER -