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Antibiotic choice and patient outcomes in community-acquired pneumonia
1St. Claire Medical Center, Morehead, Kentucky.
Background:
We investigated whether any clinical or nonclinical variables were associated with physician choice of antibiotic therapy and whether outcome differences existed among patients given agents to treat infections caused by atypical gram-negative organisms.
Methods:
A retrospective review of 157 immunocompetent patients admitted to a hospital between 1 February 1992 and 31 January 1993 with a diagnosis of community-acquired pneumonia was performed. Patient groups were defined by whether their initial antibiotic therapy was a broader spectrum antibiotic, such as a second- or third-generation cephalosporin, which would treat atypical gram-negative infection (n = 85), or narrower spectrum agents, such as ampicillin or erythromycin (n = 72).
Results:
Patients who were given broader spectrum antibiotics were slightly older than those receiving narrower agents (73 versus 66 years, P = 0.06). Otherwise, no clinical factors or comorbid states were associated with antibiotic selection. When examining physician-related factors, internists were more likely to prescribe broad-spectrum agents than were family physicians. No differences existed in overall mortality, length of stay, readmission rate, or change in antibiotic.
Conclusions:
Although physicians appear to prescribe broader agents for pneumonia in older patients, there were no other clinical predictors of antibiotic selection. Physician-related factors, such as training and specialty, might influence prescribing habits.
Insights
Physician antibiotic choice for pneumonia is not strongly linked to patient factors, but internists may favor broader-spectrum drugs. This suggests physician specialty influences prescribing habits, not just clinical indicators.
Area of Science:
- Infectious Diseases
- Clinical Pharmacy
- Internal Medicine
Background:
- Investigated clinical and nonclinical factors influencing physician antibiotic selection for community-acquired pneumonia.
- Examined outcomes in patients receiving broad-spectrum antibiotics for atypical gram-negative organisms.
Purpose of the Study:
- To determine if clinical or nonclinical variables predict physician antibiotic choice.
- To assess outcome differences based on antibiotic spectrum for atypical gram-negative infections.
Main Methods:
- Retrospective review of 157 immunocompetent patients with community-acquired pneumonia.
- Grouped patients by initial antibiotic therapy: broad-spectrum (n=85) vs. narrow-spectrum (n=72).
Main Results:
- Broader-spectrum antibiotics were prescribed to slightly older patients (73 vs. 66 years).
- No other clinical factors or comorbidities correlated with antibiotic selection.
- Internists were more likely to prescribe broad-spectrum agents than family physicians.
Conclusions:
- Physician specialty, not patient clinical factors, appears to influence antibiotic selection for pneumonia.
- Broader agents may be preferentially prescribed for older patients, but other clinical predictors are lacking.