Evaluating duration of antimicrobial therapy for community-acquired pneumonia in clinically stable patients

Abstract

"In the United States, community-acquired pneumonia (CAP) results in an estimated 2 to 3 million diagnoses each year, 10 million physician visits, and 600,000 hospitalizations resulting in a total cost of over 20 billion dollars annually. Common causative organisms of CAP include Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila. Identifying the etiologic organism helps guide therapeutic decisions, however, the pathogen remains unknown in about 50 percent of cases. Therefore, optimal empiric therapy relies on a physician's experience and clinical judgment. The Infectious Diseases Society of America (IDSA) guidelines for treatment of community-acquired pneumonia (CAP) recommend a minimum 5-day course of antibiotics for patients who achieve clinical stability within 48 to 72 hours from initiation of appropriate therapy. A multicenter, cohort study of 686 patients hospitalized with CAP found that most were treated for 7 to 10 days despite median time to clinical stability of 3 days, indicating that a shorter duration of therapy is often not favored by clinicians despite guideline recommendations. Moreover, although many patients receive active antimicrobial therapy while hospitalized, additional courses of antimicrobials are often prescribed upon discharge resulting in excessive antibiotic use. While many patients are given prolonged courses of therapy for CAP, shorter durations of antibiotics in patients eligible for such courses of treatment offer a number of advantages such as minimizing the emergence and selection of resistant organisms, increasing patient compliance, and reducing the risk of medication adverse effects. The objective of this study was to assess the percentage of hospitalized patients diagnosed with uncomplicated CAP receiving antimicrobial therapy in excess of the guideline-recommended duration, evaluate subsequent thirty-day all-cause readmission rates, and determine if select co-morbidities influenced the length of antimicrobial therapy prescribed."--Introduction.