Comparison of length of stay in community-acquired pneumonia patients who fit protocol for pharmacy driven de-escalation of ceftriaxone to standard of care

Purpose

Community-acquired pneumonia (CAP) represents a significant burden on healthcare systems, often necessitating prolonged hospital stays and substantial costs. Studies have demonstrated the safety and efficacy of early switching from intravenous (IV) to oral antibiotics in CAP, yet there remains underutilization of this practice, particularly for antibiotics with no bioequivalent analogs like ceftriaxone. This study evaluated the outcomes of pharmacy driven protocol to switch patients from IV to oral antibiotics in CAP.

Methods

This retrospective, multi-center, observational cohort study evaluated the impact of a pharmacy-led protocol for IV to oral de-escalation of ceftriaxone in CAP patients within a large healthcare system. A collaborative drug therapy management agreement enabled pharmacists to initiate de-escalation in eligible patients meeting pre-specified stability criteria.

Results

Analysis of 2314 participants (pre-implementation n = 1735; post-implementation n = 579) revealed a modest but statistically significant reduction in length of stay (4.87 to 4.57 days, p = 0.0461) and duration of ceftriaxone therapy (3.24 to 2.77 days, p < 0.01) post-implementation. Total antibiotic duration increased slightly post-implementation without statistical significance (12.7 to 13.3 days, p = 0.11), and there was no significant difference in all-cause 30-day readmission rates (p = 0.36).

Conclusion

These findings underscore the potential benefits of pharmacist driven IV to oral de-escalation protocols in optimizing antibiotic and resource utilization in CAP management. Future prospective studies are needed to validate these findings and explore broader implementation strategies in diverse healthcare settings.