The splendor of care for patients ...

The splendor of care for patients with community-acquired pneumonia (CAP) is substantial in the United States. greatest in number of the cost comes from treatment of patients in the hospital setting, which accounts for 89 percent of the $84 billion exhausted annually on the treatment of patients with CAP. Inpatient care of patients with CAP usually consists of intravenous antibiotics during the initial phase of the treatment course, followed according to a switch to oral antibiotics. new studies have shown that there can be favorable issues and reductions in length of stay and costliness if patients are treated and nothing else with oral antibiotics. Oral therapy probably is preferr by the agency of patients and could avoid potential complications from intravenous access. Although guidelines make acceptable oral therapy in selected patients with CAP, hardly any data support this concept. Marras and colleagues evaluated the efficacy of oral antibiotics in hospitalized patients with CAP and assessed risk factors that would prevent oral therapy.

The reflection design was a meta-analysis of published data comparing inpatient oral and parenteral therapy in patients with CAP. The authors searched multiple databases for published articles and searched evidence-based medicine reviews. The studies were rated using a standardized rating scale, and the issues of clinical success and mortality were summarized. The authors also performed a retrospective analysis of the medical records of patients admitted to couple urban teaching hospitals with the diagnosis of CAP. Patients were considered to be treated with oral therapy if they received no intravenous antibiotics during the hospitalization. issue measures included length of stay and mortality. expense of the antibiotics also was analyzed.

Seven studies with a total of 1366 patients were included in the meta-analysis. No significant difference was plant in the relative risk for mortality at the cessation of treatment or at follow-up between patients who received oral versus intravenous antibiotic therapy. The mean hospital stay was shorter in the assemblage receiving oral therapy than in the collection receiving intravenous treatment.

The retrospective part of the subject of attention included 698 patients, with 18 percent receiving oral antibiotic therapy. Patients who received oral therapy were younger and had a lower mean pneumonia severity index than those who received intravenous therapy. Median longitudinal dimensions of hospitalization was 1.3 days shorter in the oral antibiotic treatment assemblage and antibiotic costs were $56 les than costlinesss in the intravenous treatment collection This cost included only the medication and did not include any indirect require to be paid [i]or[/i] undergones There was no significant difference in mortality rates between the treatment groups

The authors determine that, in certain hospitalized patients with CAP, oral antibiotics are effective. The data were inadequate to determine which risk factors should determine the road of antibiotic administration. They add that the selection of the way of administration must be individualized, on the other hand that oral administration provides an option that causes les discomfort for patients and diminishs the potential complications associated with intravenous access.

KARL E MILLER, MD Marras TK et al. Efficacy of exclusively oral antibiotic therapy in patients hospitalized with nonsevere community-acquired pneumonia: a retrospective research and meta-analysis. Am J M March 15 2004;116:385-93

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