Improving antibiotic prescribing in the emergency department for uncomplicated community-acquired pneumonia (original) (raw)
Related papers
European Respiratory Journal, 2012
Do physicians apply an early-switch strategy (from intravenous to oral antibiotics) in clinically stable patients hospitalised with community-acquired pneumonia (CAP)? If not, why not? In a multicentre prospective cohort study, adult patients admitted for i.v. CAP treatment were included. On day 3 of antibiotic treatment, clinical stability was assessed and treating resident physicians were interviewed on their switch strategies. Additionally, treating physicians were interviewed to evaluate their knowledge of and adherence to guideline advice. 149 (92%) out of 162 patients were included and 97 (91%) out of 107 physicians were interviewed. A switch to oral antibiotics was possible in 68 (46%) out of 149 patients on day 3 of treatment but not performed in 27 (40%) out of 68. Patient factors delaying the switch were high CURB-65 (confusion of new onset, urea .7 mmol?L-1 , respiratory rate of o30 breaths?min-1 , blood pressure ,90 mmHg or diastolic blood pressure f60 mmHg, and age o65 yrs) score (on admission) (p50.04) and oxygen treatment (p50.04), high temperature (p50.00) and high respiration rate (p50.04) (day 3). Physicians' barriers to an early switch in clinically stable patients included misconceptions (26 (55%) out of 47), practical considerations (13 (28%) out of 47) and organisational factors (eight (17%) out of 47). Strikingly, 91 (94%) out of 97 interviewed physicians were not aware of guideline advice. The switch from i.v. to oral antibiotics is often unnecessarily delayed in patients hospitalised with CAP due to different types of barriers.
The IDSA/ATS consensus guidelines on the management of CAP in adults
Breathe, 2007
, the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) issued a consensus guidelines document on the management of community-acquired pneumonia (CAP) [1]. The document includes important advances and unifies the previous guidelines released separately by the two societies.
Hospital Pharmacy, 2016
Background: Prior to 2012, The Joint Commission (TJC) pneumonia core measure (PN-5) required antibiotic administration for suspected community-acquired pneumonia (CAP) within 6 hours of arrival to the emergency room (ER). In 2012, TJC issued PN-6 requiring antibiotic administration within 24 hours of presentation. Though PN-6 was anticipated to reduce overuse and inappropriate antibiotic use and improve appropriate antibiotic selection, the impact of PN-5 and PN-6 on optimizing care for CAP in the ER remains unknown. Objective: To investigate the impact of TJC pneumonia core measures on antibiotic use in the ER for suspected CAP. Methods: In this single-center study, medical records of patients 18 years old and older diagnosed with CAP in the ER during 2011 (PN-5) and 2012 (PN-6) and admitted for 1 day or longer were reviewed. Exclusion criteria included criteria for health care-associated pneumonia. Comparisons between groups were performed using descriptive statistics and contingency table analysis with chi-square or Fisher exact tests for categorical variables and t tests for continuous variables. Statistical analyses were performed using Microsoft Excel 2010 and SAS version 9.4. Results: Antibiotic use was comparable between PN-5 and PN-6. Approximately half of patients in each group received an appropriate empiric CAP regimen (52% vs 54%; P = .807). Among inappropriate regimens, the most common reason was use of a beta-lactam alone (69% vs 83%; P = .26). More patients had an ultimate diagnosis of CAP with PN-6 (78% vs 86%; P = .3). Conclusion: Changes in pneumonia core measure requirements did not have a significant impact on appropriate antibiotic use in the ER.
Confidently rule out CAP in the outpatient setting
The Journal of Family Practice
A focus on specific signs and symptoms-without imaging-may rule out community-acquired pneumonia in outpatients. PRACTICE CHANGER You can safely rule out community-acquired pneumonia (CAP)-without requiring a chest x-ray-in an otherwise healthy adult outpatient who has an acute cough, a normal pulmonary exam, and normal vital signs using this simple clinical decision rule (CDR). 1 STRENGTH OF RECOMMENDATION A: Based on a systematic review of prospective case-control studies and randomized controlled trials in the outpatient setting. 1 Marchello CS, Ebell MH, Dale AP, et al. Signs and symptoms that rule out community-acquired pneumonia in outpatient adults: a systematic review and meta-analysis.