Clinical studyEfficacy of exclusively oral antibiotic therapy in patients hospitalized with nonsevere community-acquired pneumonia: a retrospective study and meta-analysis
Section snippets
Meta-analysis
We identified studies of oral and parenteral antibiotic therapies for adult inpatients with community-acquired pneumonia. Studies had to have presented data on clinical improvement or success, mortality, or length of stay. We searched MEDLINE (1966 to March 2003; and PreMEDLINE until May 15, 2003) and EMBASE (1980 to March 2003) using the terms pneumo (truncated), bronchopneumonia, or lower respiratory tract infection; combined with hospitalization, hospital (truncated), admit, or admission;
Meta-analysis
The search yielded 63 studies, of which 48 were rejected because patients in both groups received parenteral therapy (38 compared switch and parenteral therapy, 10 compared different parenteral regimens), five were rejected because they compared different oral regimens, and three were rejected because they included patients with hospital-acquired pneumonia. The seven eligible studies (Appendix) included 1366 patients, of whom 616 (45%) received oral therapy and 750 (55%) received parenteral
Discussion
Our meta-analysis of exclusively oral antibiotic treatment in hospitalized patients with community-acquired pneumonia found similar outcomes in orally and parenterally treated patients. The results, however, should be interpreted in light of several factors. First, younger age in the oral group suggests an inadvertent failure of randomization. Since age is a major determinant of mortality in this disease (11), orally treated patients may have had a lower risk. Second, patients with severe
Acknowledgements
We are indebted to Linda Jamieson, RN, for data collection and database maintenance, and Leslie Lee Pack for database design and maintenance.
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