Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
To the Editor: Dr Halm and colleagues1 assessed the point of stabilization of clinical signs and symptoms of pneumonia as patients recover. However, the critical issue is whether a patient who is being treated for community-acquired pneumonia (CAP) needs to have full resolution of these signs of infection prior to changing to oral antibiotic therapy. To my knowledge, no study has proven that intravenous (IV) therapy is critical to patients' recovery from pneumonia if patients are able to take oral medications.
In our study of CAP in 75 hospitalized veterans, we randomized patients to 2, 5, or 10 days of IV antibiotics, and all patients completed 10 days of antibiotic therapy with IV cefuroxime or oral cefuroxime axetil.2 Only patients who remained febrile or experienced clinical deterioration were not changed to oral therapy. No difference in outcomes was observed. As long as the patient can swallow and absorb oral antibiotics, complication rates might be the same, even if oral antibiotics are begun on day 2, as in our study, or after 1 IV dose.
The lung is a highly vascular organ. If there are no signs of parenchymal breakdown, such as necrotizing pneumonia or abscess impeding drug penetration, and the infecting organism is susceptible to the antibiotic, IV therapy may offer little benefit. What is now needed is a prospective randomized study of patients hospitalized with CAP in which patients are converted from IV to oral therapy based on a clear point of clinical stability vs a group converted after a predetermined brief period of IV therapy. I believe the outcomes will be the same, and the 3 to 4 days of potentially unnecessary hospitalization will be saved.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Journal of American Medical Association editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.