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Common mistakes to avoid when treating pneumonia in the hospital

NEW ORLEANS — When treating pneumonia in the hospital, physicians should be careful to avoid common mistakes, Joanna M. Bonsall, MD, PhD, from the division of hospital medicine at Emory University, said during her presentation at the ACP Internal Medicine Meeting.

One common mistake physicians make is not using steroids in patients with severe community-acquired pneumonia, according to Bonsall.

She recommended using 20 mg to 60 mg of prednisone for 3 to 7 days. However, she noted that immunocompromised patients and those with uncontrolled diabetes, psychiatric disease, recent gastrointestinal bleeding and influenza should not be treated with steroids.

Another common mistake is treating pneumonia for too long, according to Bonsall.

Bonsall noted a study that found that 86% of inpatients with uncomplicated pneumonia were prescribed antibiotic therapy for longer than the recommended duration at an average of 10 days.

Community-acquired pneumonia should be treated for 5 to 7 days, she advised.

“Don’t forget that 3 days of additional treatment after clinical stability can be prescribed,” Bonsall said. “So if your patient is still sick on day 4, it is okay to extend treatment for another couple of days. But don’t prescribe an additional 5 days of antibiotics because it is the easiest.”

The last common mistake physicians should avoid is treating pneumonia too broadly, according to Bonsall.

“Don’t reflexively order piperacillin-tazobactam when a patient only has one or two risk factors and is not particularly sick,” she advised.

“One day, we will have a beautiful algorithm, but for now, just be thoughtful when you’re prescribing — consider the risks for multidrug-resistant infections and get sputum cultures if you can,” Bonsall said.

Additionally, when treating hospital-acquired pneumonia, it is important not to overuse vancomycin. – by Alaina Tedesco

Reference:

Bonsall JM. “Community-acquired pneumonia in the hospital.” Presented at: ACP Internal Medicine Annual Meeting. April 19-21, 2018; New Orleans.

Disclosure: Bonsall reports no relevant financial disclosures.