Purpose: To assess the efficacy of oral antibiotics in patients hospitalized with community-acquired pneumonia and to identify factors precluding oral therapy.
Methods: In a meta-analysis, we compared inpatient oral and parenteral therapy in community-acquired pneumonia. Studies were reviewed independently and rated by two reviewers, and results were summarized. We also performed a retrospective cohort study of hospitalized patients with community-acquired pneumonia and compared outcomes in patients treated with oral versus parenteral therapy.
Results: For the meta-analysis, we identified seven studies involving 1366 patients. Study exclusions included severe pneumonia or impaired oral absorption. There was no significant difference in the relative risk of mortality at the end of treatment or at follow-up. Mean length of hospital stay was shorter (6.1 days vs. 7.8 days) in patients taking oral antibiotics than in those taking the parental form. In the retrospective cohort, 18% (124/698) of patients received oral-only therapy; these patients were younger (median age, 75 vs. 78 years, P = 0.01) and had lower mean pneumonia severity index scores (101 vs. 119, P <0.0001) than those who received parenteral therapy. In multivariable models, oral-only patients had a median length of stay that was 1.3 days shorter (95% CI: 0.4% to 2.2% days; P = 0.008) and a median antibiotic cost that was 56 dollars lower (95% CI: 53 dollars to 58 dollars; P <0.0001) than that of patients in the parenteral group, but mortality was similar.
Conclusion: Although prospective data are limited, oral antibiotics in certain hospitalized patients with community-acquired pneumonia are effective. More data are needed to identify appropriate candidates for exclusively oral antibiotic therapy.