Oral versus intravenous antibiotic treatment of moderate-to-severe community-acquired pneumonia: a propensity score matched study

• Published in: Scientific reports Vol. 14; no. 1; p. 8271
• Main Authors: Kaal, Anna G., Roos, Rick, de Jong, Pieter, Pepping, Rianne M. C., van den Berg, Johanna M. W., van Aken, Maarten O., Steyerberg, Ewout W., Numans, Mattijs E., van Nieuwkoop, Cees
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 09.04.2024; Nature Publishing Group; Nature Portfolio
• Subjects: 692/308/409; 692/699/1785; 692/699/255/1318; Adult; Aged; Anti-Bacterial Agents - therapeutic use; Antibiotics; Blood culture; Cohort Studies; Community-Acquired Infections - drug therapy; Emergency medical care; Female; Humanities and Social Sciences; Humans; Intravenous administration; Length of Stay; Male; multidisciplinary; Observational studies; Patients; Pneumonia; Pneumonia - drug therapy; Propensity Score; Regression analysis; Retrospective Studies; Science; Science (multidisciplinary)
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-024-59026-2

Community-acquired Pneumonia (CAP) guidelines generally recommend to admit patients with moderate-to-severe CAP and start treatment with intravenous antibiotics. This study aims to explore the clinical outcomes of oral antibiotics in patients with moderate-to-severe CAP. We performed a nested cohort study of an observational study including all adult patients presenting to the emergency department of the Haga Teaching Hospital, the Netherlands, between April 2019 and May 2020, who had a blood culture drawn. We conducted propensity score matching with logistic and linear regression analysis to compare patients with moderate-to-severe CAP (Pneumonia Severity Index class III–V) treated with oral antibiotics to patients treated with intravenous antibiotics. Outcomes were 30-day mortality, intensive care unit admission, readmission, length of stay (LOS) and length of antibiotic treatment. Of the original 314 patients, 71 orally treated patients were matched with 102 intravenously treated patients. The mean age was 73 years and 58% were male. We found no significant differences in outcomes between the oral and intravenous group, except for an increased LOS of + 2.6 days (95% confidence interval 1.2–4.0, p value < 0.001) in those treated intravenously. We conclude that oral antibiotics might be a safe and effective treatment for moderate-to-severe CAP for selected patients based on the clinical judgement of the attending physician.