Switch Therapy in Community-Acquired Pneumonia

Ramirez and colleagues¹ recently reported the reduction in hospital stay and efficacy of an early switch from intravenous cephalosporin therapy to oral cefixime therapy in patients with noncomplicated community-acquired bacterial pneumonia. We wish to raise a number of issues pertinent to oral switch therapy and clinical practice in the United Kingdom.

A recent European survey revealed that in the United Kingdom 60% of all in-hospital antibiotic prescriptions are oral as opposed to our European² and North American counterparts, where inpatient parenteral therapy is more commonly prescribed. Indeed, in our own infectious disease unit, which is a tertiary referral center, over a 1-year period only 20% of antibiotic prescriptions were intravenous, and the median duration of hospital stay for patients receiving antibiotics intravenously was 3 days. Despite the encouraging evidence for the use of the oral route within our own unit and other hospitals in the United Kingdom, the