Empiric Antibiotic Prescribing For Community Acquired Pneumonia and Patient Characteristics Associated with Broad Spectrum Antibiotic Use
Objectives: To assess adherence to the Australian Therapeutic Guideline (ATG) for the empirical management of community acquired pneumonia(CAP) during the first 24 hours of admission and to investigate patient characteristics associated with the prescription of broad spectrum antibiotics in mild to moderately severe pneumonia. Methods: A retrospective cross-sectional study of patients admitted with CAP over a 12 month period under the General Medical Unit was undertaken. CAP was defined by acute onset respiratory symptoms with a new chest X-RAY infiltrate for which the treating team made a diagnosis of CAP. Pneumonia severity was assessed using the CORB score. Relevant data were collected from medical records. Results: 395 patients with CAP were identified, of which 285 were included. Mean age 66 ± 16 years; Males 53% and 12% from residential care. 167 (59%), 75 (26%), and 43 (15%) patients were in the mild, moderate and severe CAP groups, respectively. 93% patients received antibiotic cover for both typical and atypical pathogens, although 35% in the mild to moderate group received parenteral macrolide. 62% received Ceftriaxone; 92 (55%), 53 (71%) and 33 (77%) with mild, moderate and severe CAP, respectively. Compliance with ATG was seen in 16%, 27% and 72% cases of mild, moderate and severe CAP, with an overall compliance of 26%. Advanced age and dependent in personal activities of daily living (PADL) had a significant univariate association with ceftriaxone prescription. However, in the multivariate analysis, only advanced age was found to have a significant association. The length of stay was similar between those who received ceftriaxone (4.3 ± 2.4 days) and benzylpenicillin (4.1 ± 2.0 days) Conclusion: Adherence to the ATG guideline is poor, especially in the mild to moderately severe disease. Older patients are more likely to receive ceftriaxone. Studies are required to identify the barriers to adherence to CAP guidelines and factors that influence the prescription of broad spectrum antibiotics.
Mahesan Anpalahan*, Mirza Baig, Evan Newnham, Roza Nastovska, Jessica Manzoni, Daniel Clayton-Chubb
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