Ramirez and colleagues1 recently reported the reduction in hospital stay and efficacy of an early switch from intravenous cephalosporin therapy to oral cefixime therapy in patients with noncomplicated community-acquired bacterial pneumonia. We wish to raise a number of issues pertinent to oral switch therapy and clinical practice in the United Kingdom.
A recent European survey revealed that in the United Kingdom 60% of all in-hospital antibiotic prescriptions are oral as opposed to our European2 and North American counterparts, where inpatient parenteral therapy is more commonly prescribed. Indeed, in our own infectious disease unit, which is a tertiary referral center, over a 1-year period only 20% of antibiotic prescriptions were intravenous, and the median duration of hospital stay for patients receiving antibiotics intravenously was 3 days. Despite the encouraging evidence for the use of the oral route within our own unit and other hospitals in the United Kingdom, the
Nathwani D, Boyter A, Fegan PG, Davey P. Switch Therapy in Community-Acquired Pneumonia. Arch Intern Med. 1996;156(11):1235. doi:10.1001/archinte.1996.00440100133015