Empiric Antibiotic Prescribing for Community Acquired Pneumonia and Patient Characteristics Associated with Broad Spectrum Antibiotic Use
Authors: Baig Mirza Abdullah1, Anpalahan Mahesan1,2, Newnham Evan1, Nastovska Roza1, Manzoni Jessica1, Clayton-Cubb Daniel1
Affiliations: 1Deparment of Medicine, Eastern Health, Victoria, Australia, 2North West Academic Centre, The University of Melbourne, Australia
Aims: To assess adherence to the Australian Therapeutic Guideline(ATG) for the empirical management of community acquired pneumonia(CAP) during the first 24 hours of admission and to investigate patient characteristics associated with the prescription of broad spectrum antibiotics in mild to moderately severe pneumonia.
Methods: A retrospective cross-sectional study of patients admitted with CAP over a 12 month period under the General Medical Unit was undertaken. Pneumonia severity was assessed by estimating the CORB score. Relevant data were collected by review of medical records.
Results: 395 patients with CAP were identified, of which 285 were included. Mean age 66 ±16 years; Males 53% and 12% from residential care. 167(59%), 75(26%), and 43(15%) patients were in the mild, moderate and severe CAP groups, respectively. 93% patients received antibiotic cover for both typical and atypical pathogens, although 35% with mild to moderate CAP received parenteral macrolide. 177(62%) received Ceftriaxone; 92(55%), 53(71%) and 33(77%) with mild, moderate and severe CAP, respectively. Compliance with ATG was seen in 16%, 27% and 72% cases of mild, moderate and severe CAP, respectively, with an overall compliance of 26%. Advanced age and dependent in personal activities of daily living (PADL) had a significant univariate association with ceftriaxone prescription. However, after multivariable adjustment only advanced age had a significant association (adjusted odds ratio:1.78 (95% CI 1.23-2.01). The length of stay was similar between those who received ceftriaxone(4.3± 2.4 days) and benzylpenicillin(4.1 ±2.0 days). Neither group had any deaths or admission to HDU/ICU.
Conclusion: Adherence to the ATG guideline is poor, especially in those with mild to moderate CAP. Advanced age is associated with increased ceftriaxone use in mild to moderate disease, although it may not improve patient outcomes.