Pneumonia: Study Finds US Treatment Guidelines Followed in Middle East

Hospitals in the Middle East are using US medical guidelines in treating patients with community-acquired pneumonia (CAP), a study has found. The finding has additional significance because of global concerns about Middle Eastern Respiratory Syndrome. and antibiotic resistance.

People hospitalized with CAP in the United Arab Emirates, Kuwait, Bahrain, Oman, and Qatar are getting care that complies with the recent Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS) guidelines, researchers found. Bassam Mahboub, MD, and colleagues conducted a prospective, observational study between January 2009 and February 2011. They published the results of their work in BMC Pulmonary Medicine on September 30, 2015.

The study was funded by Sanofi.

The researchers considered a total of 684 patients, all of whom were adults and hospitalized with CAP. Information about medical history, mortality-risk scores, diagnostic criteria, antibiotic treatment, isolated pathogens, and both clinical and radiographic outcomes was collected. The researchers then compared the care practices for these patients with the guidelines provided by the IDSA/ATS.

The 684 participants in the study were seen by a total of 39 physicians from 38 care centers in the five participating countries. All of the patients were hospitalized, and all were given intravenous antibiotics. Most, 80% were switched to oral antibiotics within about 3 days. Most of the patients (77.9%) were treated with a single antimicrobial agent, usually levofloxacin.

At the time of discharge, patients had stable vital signs for 24 hours, were able to take oral medications, could eat and drink normally, and were evaluated as being in a normal mental condition. Only 77.6% of patients had a normal leukocyte count upon discharge, and only 31.4% had a complete radiographic recovery. Most of the patients (91.5%) were prescribed oral antimicrobial therapy.

Researchers followed up with the patients, on average, 9 days after discharge, and again 11 days after the first follow up. The follow up information was collected either by phone or during a hospital visit. Nearly all patients (99.5%) recovered successfully.

Overall, the researchers found that the guidelines suggested by IDSA/ATS for the treatment of CAPS are being followed in the Gulf Arab countries that participated in this study. One area where the guidelines are not being followed is in the isolation and characterization of the pathogens responsible for the illness. The researchers conclude that “the management of CAP in this region is generally in line with the current IDSA/ATS guidelines, though the rates of pathogen characterization and post-discharge follow-up need to be improved.”