The effect of early switching from intravenous to oral antibiotic therapy: a randomized controlled trial

Context: The benefit of early switching from intravenous (IV) to oral (PO) antibiotic therapy has been controversial during the last few decades. Aims: To evaluate the effect of early switching from IV to PO antibiotics on treatment outcomes in surgical patients at one of the largest public hospitals. Methods: Two hundred and nine patients admitted for a therapeutic antibiotic to orthopedic and general surgery conditions were randomly assigned into three groups: control (non-switching) (n = 69), early switching within 48-72 hours (n = 66), and late switching after 72 hours (n = 74). The rate of effectiveness, length of hospital stay, and cost were recorded and analyzed. Results: Treatment effectiveness was not significantly different among the three groups. However, the length of stay and cost were found reduced in early switching group, with a decrease of 2-3 days of hospital stay and 30-40% of total healthcare spending compared to late or non-switching protocol (p<0.001). Conclusions: Early switching does not compromise the outcome of antibiotic treatment while this protocol is superior to non-switching and late-switching in terms of length of hospital stay and cost of treatment. Early switching should be considered for surgery patients to optimize the treatment.