Six RCTs were included (n=1,219): four scored 3 points for quality; two scored 2; and one scored 1. None were blinded. In all studies prognostic factors in the two groups were comparable at baseline.
There were no statistically significant differences between early switch and conventional treatment groups in terms of treatment success (three RCTs, n=987 intention-to-treat patients), mortality (five RCTs, n=619 intention-to-treat patients) or recurrent infection rates (five RCTs, n=385 clinically or microbiologically evaluable patients).
Early switch treatment was associated with a significantly shorter hospital stay (WMD -3.34 days, 95% CI: -4.42 to -2.25; five RCTs, n=600 clinically evaluable patients, I2=88.5%) and fewer drug-related adverse events (OR 0.65, 95% CI: 0.48 to 0.89; five RCTs) or withdrawals for adverse events (OR 0.49, 95% CI: 0.27 to 0.89; four RCTs). Subgroup analyses in clinically evaluable patients with severe CAP showed similar results. There were insufficient data for the assessment of pathogen eradication.