In their letter, investigators from the Institute of Internal Medicine and Geriatrics of the University of Siena express concern about the early switch from intravenous (IV) to oral therapy and early hospital discharge in elderly patients with CAP. The investigators "think that in elderly patients with CAP, hospital discharge after 3 or 4 days could be too early."
Our first research protocol to evaluate if the early switch from IV to oral therapy can be safely performed in hospitalized patients with CAP was submitted to our institutional review board in 1991. At that time, we hypothesized that after initiation of IV therapy, it would be safe to switch therapy as soon as the patient shows evidence of clinical improvement, was afebrile, and the white blood cell count was returning to normal.
Ramirez JA. Community-Acquired Pneumonia in Elderly Patients and Length of Hospitalization—Reply. Arch Intern Med. 2000;160(17):2678-1679. doi: