Empiric Oral Monotherapy for Hospitalized Patients with Community-Acquired Pneumonia: An Idea Whose Time Has Come

In the past, patients hospitalized with community-acquired pneumonia (CAP) were treated entirely with parenteral antibiotics. Traditionally, severe communityacquired pneumonia (SCAP) was treated with intravenously administered antibiotics, and, by extension, this type of therapy was also administered to hospitalized patients with moderately severe community-acquired pneumonia (MSCAP). As more oral antimicrobial agents with the appropriate spectrum to treat CAP became available, infectious disease clinicians interested in antimicrobial therapy and pharmacokinetics began to use oral antimicrobial therapy in hospitalized patients. Decades ago, Dr. Harold Neu of the Columbia College of Physicians Surgeons, an authority on antimicrobial therapy and a pioneer in applying pharmacokinetic principles to the optimization of antimicrobial therapy, was the first to use oral antibiotics extensively in the intensive care setting to treat a variety of infectious diseases. He had antibiotic capsules/tablets administered orally via a nasogastric tube in the intensive care unit. He and others learned that orally administered antibiotics, even in critically ill patients, are absorbed with essentially the same efficiency and completeness that occurs in healthy individuals.