ECCMID 2023: Oral versus Intravenous Antibiotic Treatment of Moderate-to-Severe CAP: An Observational Study

One of the most common causes of hospitalisation across the world is community acquired pneumonia (CAP). For patients with moderate-to-severe CAP, guidelines recommend the administration of intravenous antibiotics. The abstract presented at the conference demonstrated the results of safety and efficacy evaluation of oral antibiotics in patients with moderate-to-severe CAP.

The evaluation was a sub-study of a large observational cohort including all adult patients presenting to the emergency department at the Haga Teaching Hospital, Netherlands. Blood samples were collected from the patients for diagnosis of CAP; patients with a diagnosis of moderate-to-severe CAP (Pneumonia Severity Index (PSI) class III-V) were included. The patients were treated with either oral or intravenous antibiotics as per the recommendation of the local guidelines. The choice of oral versus intravenous drug was based on the clinical judgement of the attending physician and intravenous antibiotics for CAP PSI class V.  Thirty-day mortality, ICU admission, readmission within 30 days, length of hospital stay, and length of antibiotic treatment were observed as the primary outcomes. 

A 30-day mortality of 4% was observed for the oral treated group while 18% was observed for the intravenous group (adjusted OR 3.9, 95% CI [1.4-11.0], p=0.008). The intravenous group had a higher risk of readmission within 30 days (adjusted OR 0.5, 95%CI 0.2-1.0, p=0.041), a longer hospital stays (adjusted coefficient 2.5, 95% CI 1.2-3.9, p<0.001) and a longer length of antibiotic treatment (adjusted coefficient 1.9, 95% CI [0.5-3.3], p=0.009). With respect to ICU admissions, there were no statistical differences between the two groups.

This sub-study concludes that oral antibiotics are a safe and effective treatment of moderate-to-severe CAP versus intravenous treatment in selected patients based on a combination of clinical prediction rules, clinical judgement and gut feeling of the physician.

European Congress of Clinical Microbiology and Infectious Disease 2023, 15th April -18th April 2023, Copenhagen, Denmark