A 5-day antibiotic stewardship target for uncomplicated community-acquired pneumonia

Antibiotic overuse in community-acquired pneumonia (CAP) persists despite guidelines recommending 5-day treatment for uncomplicated cases. Our pilot quality improvement study aimed to address this problem via an antibiotic stewardship initiative.

Adults admitted to a tertiary care center with uncomplicated CAP were identified using database query and manual chart review, with exclusions for intensive care needs, lack of clinical improvement, or concurrent infections. A 3-month baseline period was compared to a 3-month post-intervention period after provider-targeted interventions were implemented-in-person and email-based provider education on eligibility for the 5-day antibiotic course and pharmacist-driven outreach on day 3 of treatment to encourage guideline-based prescribing. Mean antibiotic duration was compared using Mann-Whitney test. The primary goal was to decrease antibiotic overuse by 25%.

Of 647 baseline patients, 222 met criteria with a mean antibiotic duration of 6.75 ± 1.75 days. After the interventions, 170 of 570 patients met criteria with a reduced antibiotic duration of 6.24 ± 1.47 days (P = .001). The antibiotic overuse decreased by 28.7%. Prolonged courses were primarily due to habitual use of traditional longer regimens, unaccounted inpatient or emergency department doses at discharge, and discrepancies between documentation and medication orders.

Our pilot study showed that a provider-focused pharmacist-driven strategy can reduce unnecessary antibiotic use in uncomplicated CAP. The intervention encouraged shorter, guideline-driven courses and reduced antibiotic overuse by 28.7%, meeting our primary goal of 25% reduction. Nevertheless, there are opportunities for further improvement in guideline adherence through enhanced discharge prescription stewardship, documentation accuracy checks, and continued provider education.