▴ Nathan RV, Rhew DC, Murray C, et al. In-hospital observation after antibiotic switch in pneumonia: a national evaluation. Am J Med2006;119:512–8OpenUrlCrossRefPubMed

This was a multicentre retrospective analysis during one of two 6 month periods in 1998–9 which assessed the benefit of in-hospital observation after the switch from intravenous to oral antibiotics in patients with community acquired pneumonia (CAP) aged at least 65 years. The US Medicare National Pneumonia Project database was used to create a sample population from 4341 hospitals in all 50 states of the US and the District of Columbia. 5248 patients fulfilled the eligibility criteria and were divided into two groups (2536 “not observed” and 2712 “observed for 1 day”).

There was no significant difference between the groups in 14 day hospital re-admission rate (7.8% in the “not observed” v 7.2% in the “observed for 1 day” group, p = 0.367) or 30 day mortality (5.1% in the “not observed” v 4.4% in the “observed for 1 day” group, p = 0.258). There were substantial economic implications of early discharge, with projected annual savings of up to $27.1 million. There were a few limitations to the study; the number of days of observation after the switch was based on calendar days and not hours, and those patients who were observed for 1 day to address active medical or social reasons were also included in the “observed for 1 day” group.

The authors conclude that low risk patients with CAP can be safely discharged soon after changing from intravenous to oral antibiotics, although there was a non-significant trend to lower 30 day mortality in those observed. The potential benefits of such an approach are shorter hospital stays and, perhaps, greater patient satisfaction. However, a randomised controlled trial is required to confirm the results of this study.