Barriers to an early switch from intravenous to oral antibiotic therapy in hospitalised patients with CAP

Do physicians apply an early switch strategy (from intravenous (IV) to oral antibiotics) in clinically stable patients hospitalised with community-acquired pneumonia (CAP)? If not, why not? In a multicenter prospective cohort study, adult patients admitted for IV CAP treatment were included. On day 3 of antibiotic treatment, clinical stability was assessed and treating residents were interviewed on their switch strategies. Additionally, treating physicians were interviewed to evaluate their knowledge of and adherence to guideline advice. 149/162 (92%) Patients were included and 97/107 (91%) physicians were interviewed. A switch to oral antibiotics was possible in 68/149 (46%) patients on day 3 of treatment, but not performed in 27/68 (40%). Patient factors delaying the switch were high CURB-score (admission) (p 0.04) and oxygen treatment (p 0.04), high temperature (p 0.00) and high respiration rate (p 0.04) (day 3). Physicians' barriers to an early switch in clinically stable patients included misconceptions (26/47, 55%), practical considerations (13/47, 28%) and organisational factors (8/47, 17%). Strikingly, 91/97 (94%) physicians were not aware of guideline advice. The switch from IV to oral antibiotics is often unnecessary delayed in patients hospitalised with CAP due to different types of barriers.