Traditionally, serious lower respiratory tract infections (LRTIs) are treated in hospital and with parenteral antibiotics. During the past decade, there has been an impetus to reduce the overall cost of antimicrobial therapy. The availability of new oral antibiotics with superior pharmacokinetics profiles and safety has enabled clinicians increasingly to consider their use in managing serious infections effectively. This article reviews the current published literature regarding the practice of switch therapy for LRTIs, examining the evidence for efficacy, safety, appropriate timing of the switch, the economic benefits, and the suitability of various antibiotics. There is an emphasis on comparing current European and US experience and examining key strategies in implementing such programs and means of assessing their impact.