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.
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