Oral versus intravenous antibiotics for community acquired lower respiratory tract infection in a general hospital: open, randomised controlled trial

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Abstract
Objective: To see whether there is a difference in outcome between patients treated with oral and intravenous antibiotics for lower respiratory tract infection. Design: Open controlled trial in patients admitted consecutively and randomised to treatment with either oral co-amoxiclav, intravenous followed by oral co-amoxiclav, or intravenous followed by oral cephalosporins. Setting: Large general hospital in Dublin. Patients: 541 patients admitted for lower respiratory tract infection during one year. Patients represented 87% of admissions with the diagnosis and excluded those who were immunocompromised and patients with severe life threatening infection. Main outcome measures: Cure, partial cure, extended antibiotic treatment, change of antibiotic, death, and cost and duration of hospital stay. Results: There were no significant differences between the groups in clinical outcome or mortality (6%). However, patients randomised to oral coamoxiclav had a significantly shorter hospital stay than the two groups given intravenous antibiotic (median 6 v 7 and 9 days respectively). In addition, oral antibiotics were cheaper, easier to administer, and if used routinely in the 800 or so patients admitted annually would lead to savings of around pounds sterling176000 a year. Conclusions: Oral antibiotics in community acquired lower respiratory tract infection are at least as efficacious as intravenous therapy. Their use reduces labour and equipment costs and may lead to earlier discharge from hospital. Key messages In patients who are not immunocompromised and do not have severe life threatening infections—that is, most—co-amoxiclav by the oral route is as effective as intravenous co-amoxiclav or third generation cephalosporins Oral treatment is easier to administer, cheaper, and associated with earlier discharge from hospital The continued routine use of intravenous antibiotics in these patients cannot be justified