PURPOSE: Early switch from intravenous to oral antibiotics is recommended for the treatment of hospitalized patients with community-acquired pneumonia (CAP), because of decreased duration of hospitalization and reduction of cost. We performed a multicenter, randomized trial to assess the benefit of the switch from intravenous sulbactam/ampicillin (SBT/ABPC) to oral garenoxacin (GRNX) in patients with CAP.
METHODS: Among adult CAP patients admitted between November 2008 and July 2010, patients who should be hospitalized for the intravenous treatment of antibiotics were eligible for enrollment. Patients with pneumonia severity classes II-IV assessed with Pneumonia Patient Outcomes Research Team (PORT) score (mild to moderate classes) were included. Patients, who had prior use of intravenous SBT/ABPC (6 g/day) for 3 days and fulfilled the inclusion criteria (improvement of respiratory symptom; CRP <15 mg/dL; ability of oral intake; temperature ≦38.0°C for more than 12 hours) on 4th day, were divided into two groups based on antibiotics class administered, switch group (GRNX 400 mg/day) or control group (continuous administration of SBT/ABPC). Clinical effectiveness was evaluated at the end of treatment for 4 days. The relapse of pneumonia was assessed on 7th day after treatment. The study was approved by ethics committees of participating hospitals, and all patients gave written, informed consent for their participation.
RESULTS: Efficacy rates in 54 patients for switch group and 51 for control group were 94.4% and 90.2% respectively, and the relapse of pneumonia was observed in 2 patients in each group. These results indicated that both treatments were highly effective with no significant difference between these groups.
CONCLUSIONS: Early conversion to oral GRNX was as effective as continuous intravenous treatment in patients with mild to moderate CAP.
CLINICAL IMPLICATIONS: Because oral GRNX has comparable effectiveness with intravenous SBT/ABPC in CAP patients responded to initial intravenous treatment, the benefit of decreased duration of hospitalization and reduction of cost in early switch to oral GRNX treatment is expected.
DISCLOSURE: The following authors have nothing to disclose: Jun-ichi Kadota, Katsunori Yanagihara, Yoshihiro Yamamoto, Issei Tokimatsu, Kazufumi Hiramatsu, Futoshi Higa, Masao Tateyama, Jiro Fujita, Shigeru Kohno
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