The Measurement of Time to First Antibiotic Dose for Pneumonia in the Emergency Department: A White Paper and Position Statement Prepared for the American Academy of Emergency Medicine

Initial management of pneumonia and sepsis: factors associated with improved outcome

“…Our findings, at least in the subset of patients with severe sepsis, contradict the recent recommendations of the American Academy of Emergencies that consider it useless to measure the time until the first dosage of antibiotics in CAP [30].…”

“…Moreover, in the subset of patients who received guideline-adherent antibiotics, treatment within the first 6 h was found to significantly reduce mortality. Although it has been shown that a shorter time to antibiotic initiation improves outcome [19], some authors have pointed out the harmful consequences of this measure, such as inappropriate use of antibiotics before confirming diagnosis [29,30]. Despite the debate regarding the number of hours, we corroborated the fact that when antibiotic is administered within 6 h, several outcome measurements are improved (in-hospital mortality in severe sepsis (p50.05) and lower LOS in sepsis (p,0.05)).…”

Community-acquired pneumonia as an emergency: time for an aggressive intervention to lower mortality

“…Also, most studies are heavily underpowered to find a small but relevant difference in mortality. Some authors have even raised concern about such a timescale because of the risk of overtreatment [43][44][45]. However, overtreatment is only a concern if antimicrobial treatment is inappropriately administered prior to a clear diagnosis.…”

Public Reporting of Hospital Hand Hygiene Compliance—Helpful or Harmful?

“…Some hospitals even adopted policies mandating that antibiotics be administered to patients with suspected CAP before chest radiographs were obtained. 5 Ultimately, time to first antibiotic dose within 4 hours was withdrawn as a reportable indicator. 4 In this example, an evidence-based improvement strategy would have focused on early identification of patients with suspected CAP, rapid confirmation of the diagnosis, and prompt initiation of antibiotic treatment if indicated.…”