Unnecessary antibiotic prescribing common among patients with pneumonia
Click Here to Manage Email Alerts
Nearly 20% of patients treated for pneumonia did not display pneumonia symptoms on their first day of treatment, but antibiotics were used for 3 days or more after symptoms ceased in one-third of patients, according to a large cohort study.
The study results, which were published in JAMA Network Open, suggest that there may be opportunities to improve antibiotic prescribing practices, the authors said.
“Our key findings were that many patients started on antibiotics for possible pneumonia have normal clinical signs and that antibiotics are often continued for many days after clinical signs normalize in those that do have abnormal signs when antibiotics are started,” Michael Klompas MD, MPH, hospital epidemiologist at Brigham and Women’s Hospital and professor of population medicine at Harvard Medical School, told Healio. “Our findings beg the question of why these patients are being given antibiotics and if in fact they’re necessary.”
Klompas and colleagues performed a cohort study of 12,273 patients who were treated for potential pneumonia at four hospitals in Massachusetts. Among them, 9,540 were treated for potential community-associated pneumonia (CAP) and 2,733 were treated for potential hospital-acquired pneumonia (HAP). The researchers calculated excess antibiotic prescribing by characterizing the amount of patients with clinical signs within reference ranges during their first day of antibiotic therapy, as well as the length of antibiotic therapy that was carried out after clinical signs returned to normal.
Oxygen saturation, respiratory rate, temperature and white blood cell counts fell within the reference ranges on the first day of antibiotic regimens in 13.5% of patients with HAP and 18.6% of patients with CAP, the researchers reported. In 34.8% of CAP episodes and 38.4% of HAP episodes, antibiotic use was continued for 3 days or more after clinical signs normalized. Additionally, 34.8% of all antibiotic days prescribed for pneumonia were found to potentially be unnecessary, they found.
“Take a look at the patient’s objective clinical signs like temperature, respiratory rate, oxygen saturation and white blood cell count,” he said. “If all of these are stone cold normal, then the patient probably does not have pneumonia and it’s probably safe to observe the patient rather than prescribing immediately. Likewise, if one is treating a patient for pneumonia one signal to consider assessing is resolution of clinical signs.”
Klompas said future studies could benefit from analyzing the safety of stopping antibiotic administration in patients with a pneumonia diagnosis and normal clinical signals.
“Look closely at the patient’s clinical signs when trying to decide whether to prescribe antibiotics for pneumonia or not,” Klompas said. “If they are all normal, then pneumonia may not be the right diagnosis, or if in fact the patient does have pneumonia, it may be sufficiently mild enough that you can observe alone rather than give antibiotics.”
Collapse
Click Here to Manage Email Alerts