A prospective randomized study of inpatient IV antibiotics for community-acquired pneumonia: The optimal duration of therapy

Study objective: To compare therapeutic outcome and perform a cost- benefit analysis of inpatients with community-acquired pneumonia (CAP) treated with a shortened course of IV antibiotic therapy. Design: A prospective, randomized, parallel group study with a follow-up period of 28 days. Setting: Bronx Veterans Affairs Medical Center (VAMC) and the Castle Point VAMC; university-affiliated VAMC general medical wards from September 1993 to March 1995. Patients: Seventy-two male veterans and 1 female veteran with 75 episodes of CAP defined by a new infiltrate on chest radiograph and either history or physical findings consistent with pneumonia. Study population was 42%(31) black, 33%(24) white, and 25%(18) Hispanic. Interventions: Patients were randomized (1:1:1) to 1 of 3 treatment groups: group 1 received 2 days of IV and 8 days of oral therapy; group 2 received 5 days of IV and 5 days of oral therapy; and group 3 received 10 days of IV therapy. Antibiotics consisted of cefuroxlme, 750 mg every 8 h for the IV course, and cefuroxime axetil, 500 mg every 12 h for the oral therapy. Measurements and results: No differences were found in the clinical course, cure rates, or resolution of chest radiograph abnormalities among the three groups. A significant difference was found in the length of stay (LOS) among the three groups. The mean ± SD LOS was 6 ± 3 days in group 1, 8 ± 2 days in group 2, and 11 ± 1 days in group 3. The shortened LOS could potentially save $95.5 million for the Department of Veterans Affairs and $2.9 billion for the US private sector. Conclusions: Adult patients hospitalized for CAP who are not severely ill can be successfully treated with an abbreviated (2- day) course of IV antibiotics and then switched to oral therapy. A longer course of IV therapy prolongs hospital stay and cost, without improving the therapeutic cure rate.