Most Pneumonia Patients Over Prescribed Antibiotics

A recent study from the University of Michigan has found that two-thirds of pneumonia patients receive an excessive amount of antibiotic therapy.



The examination of 43 hospitals in the Michigan Hospital Medicine Safety Consortium also revealed that antibiotics prescribed at discharge from the hospital accounted for 93.2% of the excess duration. 



"Antibiotic stewardship, which includes choosing the right drug and the right duration for each patient, has become a part of most hospitals," said lead author Valerie Vaughn, MD, MSc, assistant professor of internal medicine at the University of Michigan. "But these results show us that we need to pay more attention to stewardship at discharge.”


To examine the predictors and outcomes associated with excess duration of antibiotic treatment, investigators conducted a retrospective cohort study on 6481 general care medical patients from 43 hospitals that were discharged between Jan. 2017 and April 2018.

The primary outcome of the study was the rate of excess antibiotic treatment duration, which was defined as excess days per 30-day period. Investigators calculated excess days by subtracting each patient’s shortest effective treatment duration from the actual duration. Negative binomial generalized estimating equations were used to calculate rate ratios in order to assess predictors of 30-day rates of excess duration. 



Patient outcomes were assessed 30 days through medical records and telephone calls. Outcomes were also evaluated using logic generalized estimating equations to adjust for patient characteristics and probability of treatment.

After analyses, investigators found that 4747 (73.2%) patients had community-acquired pneumonia (CAP) and 1734 (26.8%) had health care-associated pneumonia. Two-thirds (4391 of 6481) of patients received antibiotics for longer than the shortest effective duration consistent with guidelines (71.8% [3410 of 4747] for CAP and 56.6% [981 of 1734] for HCAP).

Investigators also found that antibiotics charged at discharge accounted for 49.5% of totals with antibiotic therapy and 93.2% of excess days. Investigators noted that 99.6% of patients had an expected duration of 5 of fewer days, yet the most common duration prescribed at discharge was 5 days.

Additionally, the analyses revealed that each excess day of treatment was associated with a 5% increase in the odds of antibiotic-associated adverse events reported by patients after discharge.

"We have a perfect opportunity to really improve antibiotic use for many patients. If we can improve just one moment in time -- that prescription patients get as they leave the hospital -- we can eliminate nearly all unnecessarily prolonged treatment," Vaugh said.

In a related editorial, Brad Spellberg, MD, of the University of Southern California Medical Center, and Louis Rice, MD, of the Warren Alpert Medical School of Brown University, wrote that the current study highlights the need to adjust practice accordingly for the best interest of patients. 


“To live up to the expectations that our patients have for us and that we have for one another, we must overcome inertia and tradition and change practice when compelling evidence becomes available,” wrote Spellberg and Rice. “After dozens of RCTs and more than a decade since the initial clarion call to move to short-course therapy, it is time to adapt clinical practice for diseases that have been studied and adopt the mantra ‘shorter is better’.”




This study, titled “Excess Antibiotic Treatment Duration and Adverse Events in Patients Hospitalized With Pneumonia,” is published in the Annals of Internal Medicine.