Duration of Antibiotic Treatment in Community-Acquired Pneumonia

Uranga, Ane; España, Pedro Pablo; Bilbao, Amaia; Quintana, José M.; Arriaga, Ignacio; Intxausti, Maider; Lobo, José Luís; Tomás, Laura; Camino, Jesús; Núñez, Juan Manuel; Capelastegui, Alberto

doi:10.1001/jamainternmed.2016.3633

Cited by 231 publications

(167 citation statements)

References 44 publications

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“…24,25 However, clinical cure does not reflect patients' perspectives of recovery and, in reality, patientreported symptomatic resolution lags significantly behind physician-rated clinical cure. 1,5,26 The frequency of healthcare reconsultation reported in this study is higher than expected, given the low disease severity and comorbidity of the study population of working-age adults.…”

Section: Discussionmentioning

confidence: 99%

Healthcare reconsultation in working-age adults following hospitalisation for community-acquired pneumonia

Daniel

Bewick²,

McKeever

et al. 2018

Clinical Medicine

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Community-acquired pneumonia (CAP) is associated with prolonged symptom persistence during recovery. However, the effect of the residual symptom load on healthcare utilisation is unknown. The aim of this study was to quantify healthcare reconsultation within 28 days of hospital discharge for an index episode of CAP, and explore reasons for these reconsultations. Adults of working age admitted to any of four hospitals in the UK, with a primary diagnosis of CAP, were prospectively studied. Of 108 patients, 71 (65.7%) reconsulted healthcare services within 28 days of discharge; of these, 90.1% consulted their GP. Men were less likely to reconsult than women (adjusted odds ratio [aOR] 0.34, 95% confidence interval 0.13-0.91, p=0.032). Persistence of respiratory symptoms accounted for the majority of these reconsultations. Healthcare utilisation is high in working-age adults after an episode of hospitalised CAP and, in most cases, is due to failure to resolve index symptoms.

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Section: Discussionmentioning

confidence: 99%

Healthcare reconsultation in working-age adults following hospitalisation for community-acquired pneumonia

Daniel

Bewick²,

McKeever

et al. 2018

Clinical Medicine

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“…Furthermore, although the SAPS trial shows that procalcitonin can reduce antibiotic exposure when baseline treatment courses are already short, it remains to be seen whether similar results can be achieved simply by shortening global duration of treatment recommendations and implementing rigorous antibiotic stewardship programs. This is particularly relevant in light of recent randomized controlled trials and guidelines supporting shorter treatment courses for various infections [38–40]. …”

Section: Limitations and Areas For Future Researchmentioning

confidence: 99%

Using Procalcitonin to Guide Antibiotic Therapy

Rhee

2016

Open Forum Infectious Diseases

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Procalcitonin levels rise in response to systemic inflammation, especially of bacterial origin. Multiple randomized controlled trials have demonstrated that procalcitonin-based algorithms can safely reduce antibiotic use in 2 clinical scenarios. First, in stable, low-risk patients with respiratory infections, procalcitonin levels of <0.25 µg/L can guide the decision to withhold antibiotics or stop therapy early. Second, in critically ill patients with suspected sepsis, clinicians should not initially withhold antibiotics, but procalcitonin levels of <0.5 µg/L or levels that decrease by ≥80% from peak can guide discontinuation once patients stabilize. The recent stop antibiotics on procalcitonin guidance study (SAPS), the largest procalcitonin trial to date, demonstrated reduction in both antibiotic exposure and mortality in critically ill patients. Although procalcitonin is ready for routine use, future research should examine optimal strategies for implementation in hospitals, its real-world impact on clinical outcomes and costs, its applicability to immunocompromised patients, and the generalizability of trials to the US population.

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“…Concordance with antibiotic guidelines is associated with a shorter median LOS but there are few conclusions on other outcomes . There is evidence that physicians do ‘over‐treat’ CAP and shorter courses of more narrow spectrum antibiotics can be used without adverse events . A multi‐centre prospective study found that a switch from i.v.…”

Section: Achieving Best Outcomesmentioning

confidence: 99%

Determining best outcomes from community‐acquired pneumonia and how to achieve them

Hadfield

Bennett

2017

Respirology

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Community-acquired pneumonia (CAP) is a common acute medical illness with a standard, effective treatment that was introduced before the evidenced-based medicine era. Mortality rates have improved in recent decades but improvements have been minimal when compared to other conditions such as acute coronary syndromes. The standardized approach to treatment makes CAP a target for comparative performance and outcome measures. While easy to collect, simplistic outcomes such as mortality, readmission and length of stay are difficult to interpret as they can be affected by subjective choices and health care resources. Proposed clinical-and patient-reported outcomes are discussed below and include measures such as the time to clinical stability (TTCS) and patient satisfaction, which can be compared between health institutions. Strategies to improve these outcomes include use of a risk stratification tool, local antimicrobial guidelines with antibiotic stewardship and care bundles to include early administration of antibiotics and early mobilization.

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Duration of Antibiotic Treatment in Community-Acquired Pneumonia

Abstract: The optimal duration of antibiotic treatment for community-acquired pneumonia (CAP) has not been well established. OBJECTIVE To validate Infectious Diseases Society of America/American Thoracic Society guidelines for duration of antibiotic treatment in hospitalized patients with CAP.

Cited by 231 publications

References 44 publications

Healthcare reconsultation in working-age adults following hospitalisation for community-acquired pneumonia

Healthcare reconsultation in working-age adults following hospitalisation for community-acquired pneumonia

Using Procalcitonin to Guide Antibiotic Therapy

Determining best outcomes from community‐acquired pneumonia and how to achieve them

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