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Patients hospitalized with pneumonia often receive excess antibiotic therapy that may be associated with adverse events, according to the results of a retrospective cohort study published in the Annals of Internal Medicine.
Historically, healthcare providers have prescribed long durations of antibiotic therapy for pneumonia because of the concern of relapse or progression with shorter durations of treatment.2,3 Recent studies have demonstrated that shorter courses of antibiotic therapy are safe and equally effective for patients with pneumonia.4-9 In addition, longer courses of treatment are associated with antibiotic-associated adverse events, Clostridioides difficile infection, and multidrug-resistant organisms.10-12
Thus, researchers examined predictors and outcomes associated with excess duration of antibiotic treatment in 6481 patients with pneumonia who were treated at 43 hospitals in Michigan. They found that 67.8% of patients received excess antibiotic therapy (ie, longer than the shortest effective duration consistent with guidelines), and that antibiotics prescribed at discharge accounted for 93.2% of excess duration.
Patients more likely to receive excess treatment if they had respiratory culture or monoculture diagnostic testing, had a longer hospital stay, received a high-risk antibiotic in the last 90 days, had community-acquired pneumonia, or did not have a total antibiotic treatment duration documented at discharge. Each day of excess treatment was associated with a 5% increase in the risk for antibiotic-associated adverse events. The most commonly reported adverse events included diarrhea, gastrointestinal distress, and mucosal candidiasis.
“In conclusion, most patients hospitalized with pneumonia are treated with antibiotics for longer than necessary,” the researchers wrote. “Excess antibiotic treatment duration was associated with patient-reported adverse events after discharge.”
Future studies are needed to determine whether reducing excess treatment and improving documentation at discharge improves outcomes.
Disclosures: Dr Flanders reports receiving personal fees for expert testimony from Blue Cross Blue Shield of Michigan, and Dr Chopra reports receiving grants from Blue Cross Blue Shield of Michigan during the study.
References
1. Vaughn VM, Flanders SA, Snyder A, et al. Excess antibiotic treatment duration and adverse events in patients hospitalized with pneumonia. A multihospital cohort study. Ann Intern Med. 2019;171:153-163.
2. Niederman MS, Bass JB Jr, Campbell GD, et al. Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy. American Thoracic Society. Medical Section of the American Lung Association. Am Rev Respir Dis. 1993;148(5):1418-1426.
3. Grasela TH Jr, Welage LS, Walawander CA, et al. A nationwide survey of antibiotic prescribing patterns and clinical outcomes in patients with bacterial pneumonia. DICP. 1990;24(12):1220-1225.
4. Uranga A, Espana PP, Bilbao A, et al. Duration of antibiotic treatment in community-acquired pneumonia: a multicenter randomized clinical trial. JAMA Intern Med. 2016;176(9):1257-1265.
5. Haas MK, Dalton K, Knepper BC, et al. Effects of a syndrome-specific antibiotic stewardship intervention for inpatient community-acquired pneumonia. Open Forum Infect Dis. 2016;3(4):ofw186.
6. Avdic E, Cushinotto LA, Hughes AH, et al. Impact of an antimicrobial stewardship intervention on shortening the duration of therapy for community-acquired pneumonia. Clin Infect Dis. 2012;54(11):1581-1587.
7. Li DX, Ferrada MA, Avdic E, Tamma PD, Cosgrove SE. Sustained impact of an antibiotic stewardship intervention for community-acquired pneumonia. Infect Control Hosp Epidemiol. 2016;37(10):1243-1246.
8. Li JZ, Winston LG, Moore DH, Bent S. Efficacy of short-course antibiotic regimens for community-acquired pneumonia: a meta-analysis. Am J Med. 2007;120(9):783-790.
9. Royer S, DeMerle KM, Dickson RP, Prescott HC. Shorter versus longer courses of antibiotics for infection in hospitalized patients: a systematic review and meta-analysis. J Hosp Med. 2018;13(5):336-342.
10. Tamma PD, Avdic E, Li DX, Dzintars K, Cosgrove SE. Association of adverse events with antibiotic use in hospitalized patients. JAMA Intern Med. 2017;177(9):1308-1315.
11. Chastre J, Wolff M, Fagon JY, et al; for the PneumA Trial Group. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. 2003;290(19):2588-2598.12.
12. Singh N, Rogers P, Atwood CW, Wagener MM, Yu VL. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med. 2000;162(2 Pt 1):505-511.
