Antibiotics Utilization for Community Acquired Pneumonia in a Community Hospital Emergency Department

Abstract

Background: A local health authority in Canada implemented its own Antimicrobial Stewardship Program (ASP) which provide guidelines to clinicians to utilize when treating infectious diseases such as community-acquired pneumonia (CAP). Objectives: The primary objective is to describe antibiotic usage patterns at the community hospital’s emergency department (ED) and to analyze the patterns in relation to ASP goals of reducing risk of infections, adverse drug events and antibiotic resistance, and to identify potential areas of improvement. Methods: This retrospective chart review included 156 adult patients with a diagnosis of CAP admitted to a community hospital ED from December 1, 2015 to November 30, 2016. Results: 50.6% patients were prescribed moxifloxacin across all severity of CAP patients. Low and moderate severity CAP patients were most often prescribed antibiotic duration > 7 days. In low, moderate and high severity CAP patients who were treated using ceftriaxone, 100%, 88.9% and 66.6% patients were treated with ceftriaxone 2000 mg daily respectively. Conclusions: Antibiotic prescribing patterns suggest fluoroquinolones were frequently being over-prescribed, ceftriaxone dosages were often too high, and duration of antibiotics for low and moderate severity CAP were too long. More efforts are needed to promote appropriate antibiotic usage and optimize patient care.

Investigation of drug-related problems in patients hospitalized in chest disease wards: A randomized controlled trial

“…According to the Cherian et al study pharmacist intervention has significant effects on COPD related readmission. In addition to reduced readmission rates pharmacist interventions resulted as decreased the hospital stay, escalation of COPD therapy, increased pulmonology, physical therapy, and palliative consults in Cherian et al results (Cherian et al, 2003) Frontiers in Pharmacology frontiersin.org administered antibiotic dosages were often greater than needed (Yu et al, 2020). It should be kept in mind that such irrational use of antibiotics would increase antibiotic resistance.…”

“…In a retrospective study investigating the use of fluoroquinolone antibiotics, it was shown that 71% of the prescribed fluoroquinolones were over-prescribed for low-risk patients ( Thiessen et al, 2017 ). In another retrospective study involving 156 adult patients diagnosed with CAP in Canada, it was reported that doctors prescribed fluoroquinolones for 80.8% of their patients, even though it was not needed for the patients ( Yu et al, 2020 ). The unnecessary use of fluoroquinolones increases the risk of side effects such as tendon rupture, tendinitis, and aortic rupture and may contribute to the development of antibiotic resistance ( Bethesda, 2012 ; Stephenson et al, 2013 ; Pasternak et al, 2018 ).…”

Pneumonia: Drug-Related Problems and Hospital Readmissions

“…In Canada, a study on pneumonia showed that prescribed antibiotic doses tended to be higher than recommended [29]. In contrast, a prospective multinational study involving 68 ICUs across 10 countries confirmed that 20% of patients received less than the most conservative PK/PD target (50% f T > MIC), and fewer than 50% of patients received a preferred PK/PD target (100% f T > MIC) [13].…”

“…A retrospective chart review at a large hospital indicated that fluoroquinolones were antibiotics overprescribed for 71% of patients in the low-risk group [28]. Another retrospective chart review among 156 adult patients with a diagnosis of CAP, admitted to a community hospital emergency department in Canada, found that physicians overprescribed fluoroquinolones for 80.8% of patients who did not need them [29]. Over-prescribing of fluoroquinolones for outpatients with pneumonia increases the risk of side effects: tendon rupture, tendonitis, feeling shaky, unusual hunger, serious events of aortic ruptures or tears, and development of antibiotic resistance [30][31][32].…”

Multidisciplinary Collaboration for the Optimization of Antibiotic Prescription: Analysis of Clinical Cases of Pneumonia between Emergency, Internal Medicine, and Pharmacy Services

“…In emergency departments, for example, there is the need for active use of specific tools as guidelines for the prescription election [ 10 ] and more efforts need to be done to promote and improve appropriate antibiotic usage, optimizing patient care [ 11 ]. Thus, the combination of audit and feedback plus distribution of a pocket version of guideline recommendations as antibiotic selection tools led to a substantial increase in appropriate empirical antibiotics prescription in a study carried out in a Norwegian hospital [ 12 ].…”