The effectiveness of intravenous (IV) to oral (PO) antibiotic switch (IVOS) interventions in managing community- and hospital-acquired pneumonia-a systematic review
Abstract
Background: Prolonged intravenous (IV) antibiotic therapy in hospitalized patients with pneumonia increases healthcare costs and hospital length of stay compared to oral (PO) therapy. Antimicrobial stewardship (AMS) interventions promoting timely IV-to-PO antibiotic conversion may reduce healthcare burden without compromising patient outcomes. Optimal design and implementation of such interventions in different healthcare settings, including respiratory medicine remain unclear.
Objectives: The aim of this study was to evaluate the effectiveness of interventions designed to improve IV-to-PO antibiotic switching practices in managing community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP).
Methods: The review was registered with PROSPERO (CRD420251039180). PubMed, Scopus, Web of Science, The Cochrane Library databases were searched for studies published from 1995 to 2024 focusing on CAP and/or HAP management or antimicrobials indicated for respiratory infections. Two reviewers independently screened studies using a priori inclusion/exclusion criteria. Study quality was assessed using the Mixed Methods Appraisal Tool. Data were analysed using narrative synthesis. Clinical outcomes (cure rates, mortality, length of stay), economic outcomes (cost savings), and process measures (switching rates, IV antibiotic duration) were examined.
Results: 58 studies were included. Interventions included clinical guideline/protocol implementation (n = 40), pharmacist-led…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 40 participants or records.
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