Conversion of intravenous to oral/nasogastric antibiotics in critically ill patients with pneumonia
Keywords:Pneumonia, antibiotics, intensive care unit, switch therapy
BACKGROUND: Considering the fiscal restraints on health care, an intravenous (IV) to oral/nasogastric (PO/NG) conversion program for critically ill patients with community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) was developed.
OBJECTIVE: Our purpose was to evaluate the feasibility of implementing an IV to PO/NG conversion program in this population and to assess patient outcomes.
METHODS: Intensive care unit (ICU) patients diagnosed with CAP and HAP were eligible for enrollment. Patients that met predefined criteria were converted to an enteral regimen. Temperature, white blood cell counts and oxygen requirements were evaluated at baseline, time of conversion and end of oral therapy. Treatment courses were evaluated for clinical and microbiological outcomes.
RESULTS: During a 5-month period, 26 ICU patients were entered into this trial (13 CAP and 13 HAP). Mean age (± SD) was 61 (17.3) and 55.8 (20) years old, and mean Acute Physiology and Chronic Health Evaluation II (APACHE II) scores 24 (6.7) and 19 (6.7) in the CAP and HAP groups respectively. Mechanical ventilation was required in 69.2% of patients. Conversion occurred in 77% and 92% of CAP and HAP patients after a mean of 6.6 and 5 days. Twenty patients were clinically evaluable and cure or improvement occurred in all cases. Seventeen patients had positive microbiological cultures and eradication was observed in 13 of these patients (76%).
CONCLUSION: An IV to PO/NG conversion program for critically ill patients with CAP or HAP is feasible and effective.
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