Early switch from intravenous to oral antibiotics in hospitalized patients with bacteremic community-acquired Streptococcus pneumoniae pneumonia

Arch Intern Med. 2001 Mar 26;161(6):848-50. doi: 10.1001/archinte.161.6.848.


Background: The identification of Streptococcus pneumoniae bacteremia in hospitalized patients with community-acquired pneumonia is considered by some investigators to be an exclusion criterion for early switch from intravenous to oral therapy.

Objective: To determine whether the switch from intravenous to oral therapy in such patients, once the bx;1patient reaches clinical stability, is associated with poor clinical outcome.

Methods: The medical records of 400 patients with community-acquired pneumonia hospitalized at the Veterans Affairs Medical Center of Louisville (Louisville, Ky) were reviewed to identify patients with bacteremic S pneumoniae. Four criteria were used to define when a patient reached clinical stability and should be considered a candidate for switch therapy: (1) cough and shortness of breath are improving, (2) patient is afebrile for at least 8 hours, (3) white blood cell count is normalizing, and (4) oral intake and gastrointestinal tract absorption are adequate.

Results: A total of 36 bacteremic patients were identified. No clinical failures occurred in 18 patients who reached clinical stability and were switched to oral therapy or in 7 patients who reached clinical stability and continued intravenous therapy. Clinical failures (5 deaths) occurred in the group of 11 patients who did not reach clinical stability.

Conclusion: Once a hospitalized patient with community-acquired pneumonia reaches clinical stability, it is safe to switch from intravenous to oral antibiotics even if bacteremia caused by S pneumoniae was initially documented.

MeSH terms

  • Administration, Oral
  • Anti-Bacterial Agents / administration & dosage*
  • Bacteremia / drug therapy*
  • Clinical Protocols
  • Community-Acquired Infections / drug therapy*
  • Hospitalization
  • Humans
  • Injections, Intravenous
  • Pneumonia, Pneumococcal / drug therapy*
  • Streptococcus pneumoniae / isolation & purification
  • Treatment Outcome


  • Anti-Bacterial Agents