Duration and route of antibiotic therapy in community-acquired pneumonia: switch and step-down therapy

The treatment of hospitalized patients with community-acquired pneumonia (CAP) has traditional been with intravenous antibiotics. More recently, the focus of this antibiotic therapy has been empiric and based on the most likely pathogens in a given patient. The concept of when and how to approach the patient for conversion to oral therapy, known as switch therapy, is now the focus of controversy. Recently, several studies have emerged from the literature that shed some light on the subject of switch therapy for CAP. Although the data are limited at this time, it seems clear that switching to oral antibiotics in selected low-risk patients may be feasible and safe. In this article, we focus on the problem and help formulate a practical approach to switching patients from intravenous antibiotics to oral therapy for CAP.