Most pneumonia patients prescribed unnecessary, potentially harmful antibiotics
Two thirds of hospitalized pneumonia patients receive longer durations of antibiotic therapy than necessary, which may increase their risk for adverse events according to results published in the Annals of Internal Medicine.
“Historically, providers prescribed long durations of antibiotic therapy for pneumonia because of concerns that short courses could lead to disease relapse or progression,” Valerie M. Vaughn, MD, MSc, of the University of Michigan Medical School and VA Ann Arbor Health System, and colleagues wrote. “However, recent studies, including multiple randomized controlled trials and systematic reviews, have demonstrated that shorter antibiotic therapy is safe and equally effective for most patients with pneumonia.”
The study comprised patients who were discharged from January 2017 to April 2018 with community-onset pneumonia, including community-acquired pneumonia or health care-associated pneumonia. Researchers examined patient data from 90 days prior to admission to 30 days after discharge to determine the rate of excess antibiotic treatment duration. Excess treatment duration was calculated by subtracting a patient’s expected treatment duration based on pneumonia classification, organism, and time to clinical stability from actual treatment duration.
Based on clinical guidelines, those with community-acquired pneumonia were expected to have antibiotic treatment duration of at least 5 days and those with health care–associated pneumonia were expected to have antibiotic treatment duration of at last 7 days.
Among the 6,481 patients with pneumonia included in the study, two thirds (67.8%) received excess antibiotic therapy, the overwhelming majority (93.2%) of which originated with antibiotic prescription at discharge.
Researchers also evaluated outcomes including death, readmission, ED visits, antibiotic-associated adverse events, provider-documented adverse events and patient-reported adverse events. Patient-reported events were identified during follow-up phone interviews.
Patients were more likely to receive excess duration of antibiotic treatment if they underwent respiratory cultures or nonculture diagnostic testing, had longer hospital stays, received high-risk antibiotics within 90 days of admission, had community acquired-pneumonia, and did not have antibiotic treatment duration recorded at hospital discharge.
The odds of patient-reported adverse events caused by antibiotic treatments, such as diarrhea gastrointestinal distress and mucosal candidiasis, increased by 5% with each excess day of treatment. Excess antibiotic treatment was not tied to lower rates of death, hospital readmission, ED visits, or Clostridioides difficile infection.
“Vaughn and colleagues' findings add to the considerable body of evidence supporting the antibiotic mantra ‘shorter is better,’” Brad Spellberg, MD, of Los Angeles County-University of Southern California Medical Center and Louis B. Rice, MD, of Rhode Island Hospital and the Warren Alpert Medical School at Brown University, wrote in an editorial accompanying the study. “The cumulative evidence indicates that each day of antibiotic therapy beyond the first confers a decreasing additional benet to clinical cure while increasing the burden of harm in the form of adverse effects, superinfections, and selection of antibiotic resistance.” – by Erin Michael
Disclosure: Rice reports personal fees from Macrolide and Zavante Pharmaceuticals outside the submitted work. Spellberg reports consulting for Acurx, Alexion, Merck, Paratek, Shionogi and TheoremDx and equity from BioAIM, ExBaq, Motif and Mycomed outside the submitted work. Vaughn reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.