ADVANCES IN ANTIBIOTIC USE - SWITCH THERAPY

New strategies for improving antimicrobial therapy have two primary objectives: improve patient outcome and decrease health care costs. According to the clinical situation, therapeutic use of antimicrobials can be classified as ''empiric therapy,'' ''known pathogen therapy,'' or ''switch therapy.'' In ''switch therapy'' there is an early transition from intravenous to oral antimicrobial agents to complete the total course of therapy. We have developed a series of criteria for such a transition. If these criteria are met, switch therapy can be safely applied to pulmonary, skin and soft tissue, urinary, and intraabdominal infections. Oral agent selection for switch therapy should be based on appropriate pharmacokinetics and microbiologic activity of the oral agent. We have also compared the economic efficiency of switch therapy in patients hospitalized with community-acquired pneumonia with historical controls in patients treated with conventional intravenous therapy. Overall results indicate that switch therapy offers a safe and effective means of decreasing the duration of intravenous therapy and hospitalization. It also appears to reduce health care costs while maintaining a high standard of patient care.