A systematic review 1 including 10 studies was abstracted in DARE. The most common criteria for switch were afebrile (100%), improvement or resolution of respiratory signs and symptoms (89%), and ability to take oral antibiotics (67%).
The most common criterion for discharge was care of co-morbid conditions. The 5 studies applied four different combinations of discharge criteria. The median recommended day of switching to oral antibiotic was day 3 (range: 2 to 10). The median recommended duration of parenteral antibiotics was 3 days (range: 2 to 10).
Length of stay (LOS) (5 studies): LOS ranged from 3.5 to 11 days. Six studies (458 patients) applied an early switch and early discharge strategy to an intervention and control group, and 5 studies provided standard deviations for LOS. The mean change in LOS was -1.64 days (95% confidence interval, CI: -3.30 to 0.02, P=0.05); this did not differ significantly between intervention groups.
Clinical outcomes: No significant differences were found between intervention groups for the following outcomes: complications of therapeutic failures (4 studies), mortality (3 studies), readmission (3 studies), health-related quality of life (3 studies), therapeutic success (2 studies), patient satisfaction with care (2 studies), intensive care unit admission (1 study), any adverse outcome (1 study), and relapse (1 study). No supporting data were presented.
Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies, heterogeneity in results in different populations).
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