Comparison between the Efficacy of Switch Therapy and Conventional Therapy in Pediatric Community-Acquired Pneumonia
Insights
Switching pediatric pneumonia patients to oral antibiotics early is safe and effective. This switch therapy shortens hospital stays compared to conventional treatment without increasing readmissions or affecting outcomes.
Area of Science:
- Pediatric infectious diseases
- Pharmacotherapy
- Hospital medicine
Background:
- Community-acquired pneumonia (CAP) is a common cause of hospitalization in children.
- Intravenous (IV) antibiotics are standard for hospitalized pediatric CAP, but prolonged use may increase costs and length of stay.
Purpose of the Study:
- To compare treatment outcomes of switch therapy versus conventional therapy for hospitalized pediatric CAP patients.
- To evaluate the safety and efficacy of early IV to oral antibiotic switching.
Main Methods:
- 57 pediatric patients (1 month-5 years) with CAP were randomized into switch therapy (SWT) or control groups.
- SWT involved switching from IV to oral antibiotics within 24 hours of clinical improvement and sustained normal temperature.
- Statistical analysis included Chi-square, Fisher's exact, unpaired t-tests, and Mann-Whitney U tests; non-inferiority analysis was performed.
Main Results:
- No significant differences in patient demographics or initial antibiotic types between groups.
- The SWT group had a significantly shorter length of hospital stay (P = 0.019).
- Readmission rates, morbidity, and mortality were similar; SWT demonstrated non-inferior efficacy (p<0.001).
Conclusions:
- Early switch from IV to oral antimicrobial agents in pediatric CAP is safe and effective.
- Switch therapy offers non-inferior outcomes to conventional therapy.
- Switch therapy shortens hospital stays, potentially reducing hospitalization costs.
Objective:
Compare the treatment outcomes ofswitch therapy and conventional therapy inpediatricpatients aged one month to five years old, diagnosed with community-acquired pneumonia who required hospitalization.
Material And Method:
The present study was performed and approved by the Siriraj Research Ethics Committee. With informed consent, 57 patients whofitted the inclusion criteria were randomized into two groups, 1) the switch therapy group (SWT), who switched their method of receiving antibiotics from IV to oral within 24 hours after clinical improvement and body temperature under 37.8 °C at least eight hours, and 2) the control group, the group treated as routine general practice. Chi-square tests, Fisher's exact tests, unpaired t-tests, and Mann-Whitney U tests were used in analysis. A non-inferiority analysis to estimate 1-sided 95% CIs was performed to determine the greatest difference (worst case) between groups.
Results:
There were no significant differences in age, sex, clinical presentations, and antibiotics provided between the two groups. A statistically significant reduction in length of hospital stay was found in the SWT group (P = 0.019), whereas the readmission rate for both groups was not significantly different (p = 0.66). Morbidity and mortality were not found in either groups. The SWT group demonstrated non-inferior efficacy comparing to control group (difference 20%; p<0. 001).
Conclusion:
In pediatric community-acquired pneumonia, early switching from administer IVantimicrobial agents to oral form when clinical signs improved were safe and effective. Switch therapy showed non-inferiority outcomes compared to conventional therapy, and had advantages in shortening the length ofstay and indirectly lowering the cost of hospitalization.
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