Resist the Script: Antibiotic Overuse in Pneumonia — An Expert Roundtable

Become educated about the role of climate change. Increases in coccidioidomycosis, avian influenza, Hantavirus, and aspergillosis have all been noted to increase in areas with changes in ambient temperature or rainfall.⁷ The old and young may be more susceptible to rapid changes in conditions. Climate change has already been found to increase rates of COPD and asthma, which increase the risk for infection.

Educate patients and stay up to date on changes in local pathogens and in crisis situations such as floods, fires, and draught: these can all affect local pathogens.

Dr Dela Cruz: Try to distinguish as best as possible, clinically and through diagnostics, whether the patient has a viral or bacterial cause of pneumonia. There are tests that can be performed using nasopharyngeal swabs for viruses and sputum samples for bacteria.² 

Pulmonology Advisor: What should be the next steps in this area, in terms of research or clinical practice?

Dr Niederman: [We need to] collect more data about the relationship of patient risk factors to the presence of specific bacteria and then test whether using algorithms based on this information lead to more effective and more accurate therapy than empiric regimens that are currently being used. We also need more data about the bacteriology of pneumonia in nonventilated patients, as most available data [are] not from this population, but rather from mechanically ventilated patients.²

Dr Forest: [Future research should explore] best strategies for changing both patient perception and prescriber practices to reduce overdiagnosis and overprescribing. And again, we should strive to change practice environments to favor effectiveness over efficiency.

Dr Dela Cruz: There are now more diagnostics that are high-throughput multiplex polymerase chain reaction-based assays that can rapidly identify etiology of pneumonia.² More research is needed using these and other new technologies. We also need better tools to assess the patient’s response to the lung infections.

References

1. World Health Organization. Antibiotic resistance. https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance. Accessed January 14, 2019.
2. Gautam S, Sharma L, Dela Cruz CS. Personalizing the management of pneumonia. Clin Chest Med. 2018;39(4):871-900.
3. Francino MP. Antibiotics and the human gut microbiome: dysbioses and accumulation of resistances. Front Microbiol. 2016;6:1543.
4. Niederman MS. Antibiotic treatment of hospital-acquired pneumonia: is it different from ventilator-associated pneumonia? Curr Opin Crit Care. 2018;24(5):353-360.
5. Barlam TF, Soria-Saucedo R, Cabral HJ, Kazis LE. Unnecessary antibiotics for acute respiratory tract infections: association with care setting and patient demographics. Open Forum Infect Dis. 2016;3(1):ofw045.
6. Lee MS, Oh JY, Kang C-I, et al. Guideline for antibiotic use in adults with community-acquired pneumonia. Infect Chemother. 2018;50(2):160-198.
7. Mirsaeidi M, Motahari H, Khamesi MT, Sharifi A, Campos M, Schraufnagel DE. Climate change and respiratory infections. Ann Am Thorac Soc. 2016;13(8):1223-1230.