A Cochrane review [Abstract] 1 included 15 studies with a total of 1743 subjects. Initial intravenous or intramuscular therapy followed by oral therapy was defined as switch treatment. Studies compared oral vs switch treatment (5 studies n=1040), switch vs parenteral treatment (6 trials, n=373), and single dose parenteral followed by oral therapy vs oral or switch therapy. There were a variety of short-term and long-term outcomes, but no pooled outcomes showed significant differences. Only one small trial studied oral vs parenteral treatment, parenteral therapy had better bacterial cure than oral norfloxacin. The only assessed long-term outcome was kidney scarring, and scarring does not seem to differ.
Comment: The quality of evidence is downgraded by study quality.
A systematic review 2 compared the effectiveness of short and long courses of oral antibiotics for infections treated in outpatient settings. There was no difference in the clinical cure for adults treated with short or long course antibiotics for uncomplicated cystitis (3 vs 5 days or longer) in non-pregnant women (RR 1.10, 95% CI 0.96 to 1.25; 32 studies, n=9605), or elderly women (RR: 0.98, 95% CI:0.62, 1.54; 6 studies, n=431); acute pyelonephritis (7-14 vs 14-42 days) (RR: 1.03, 95% CI 0.80 to 1.32; 2 trials, n=185); acute bacterial sinusitis; or community acquired pneumonia. No adequate evidence about the effect on antibiotic resistance was found.
Another systematic review 3 included 5 RCTs involving a total of 1003 subjects. Success of oral treatment of the outpatient pyelonephritis by cefaclor, ciprofloxacin and norfloxacin at 4 to 6 weeks was comparable at between 83 to 95%. Relatively high rates of adverse events were noted in a trial of ciprofloxacin (24%) and trimethoprim-sulfamethoxazole (33%).
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