A Nationwide Survey of Antibiotic Prescribing Patterns and Clinical Outcomes in Patients with Bacterial Pneumonia

Abstract

Antibiotic prescribing information was prospectively collected on 1822 hospitalized patients treated for suspected or documented bacterial pneumonia. Antibacterial therapy with a single antibiotic was employed in more than 50 percent of the patients, with cefazolin, cefuroxime, ampicillin, and ceftriaxone sodium representing the most commonly employed agents. Combination therapy using two antibiotics was employed in approximately 30 percent of patients with the aminoglycosides, particularly gentamicin, used extensively. A satisfactory outcome was achieved in approximately 80 percent of patients with a community- or institutional-acquired pneumonia; only 66 percent of nosocomial pneumonias had a satisfactory outcome. An important observation was the apparently common practice of switching patients to an oral antibiotic regimen after an average of seven days of antibiotics and subsequently discharging the patient. No difference was observed in the patterns of clinical response or duration of therapy for culture-positive versus culture-negative patients. The results of this surveillance program can serve as a basis for comparison of institution-specific drug utilization evaluation programs.

Associations Between Initial Antimicrobial Therapy and Medical Outcomes for Hospitalized Elderly Patients With Pneumonia

“…[6][7][8][9] Wide variations in antimicrobial prescribing practices exist for the treatment of community-acquired pneumonia. [10][11][12][13] To reduce this variation and improve the appropriateness of antimicrobial therapy, the Infectious Disease Society of America (IDSA) and the American Thoracic Society (ATS) have published guidelines for empirical antimicrobial therapy for this illness. 14,15 However, these guidelines were derived from a limited number of clinical studies of pneumonia etiology and have not been validated in clinical practice.…”

β lactam monotherapy versus β lactam-aminoglycoside combination therapy for sepsis in immunocompetent patients: systematic review and meta-analysis of randomised trials

“…In aiming for optimal antibiotic treatment of severe infections, hospital clinicians tend to use combination therapy despite the lack of direct evidence for its effectiveness. Observational studies show that 25-30% of patients with bacteraemia,10 11 surgical infections,12 or pneumonia,13 14 50% of those with klebsiella bacteraemia,15 and 56% of patients with septic shock in the intensive care unit16 are given β lactam-aminoglycoside combination therapy.…”

Evaluation of a pneumonia practice guideline in an interventional trial.

“…The average duration of hospital stay for patients with pneumonia is about 7.5 d (10d for patients over age 65) (1). Many patients are treated with parenteral antimicrobials for approximately 1 wk, then switched to oral antimicrobial therapy, and later discharged home (2,3). Previous data have demonstrated substantial differences in hospital admission rates and variations in lengths of stay for patients hospitalized with pneumonia (4)(5)(6).…”