The results of a new study suggest that antibiotics are prescribed too liberally to adult patients with pneumonia as they leave the hospital. The findings come from an analysis, led by researchers from the University of Michigan, that points to an area that may be ripe for improvement.

The analysis involved a review of the medical records of close to 6,500 pneumonia patients who were treated at 43 Michigan hospitals and phone conversations between researchers and 60% of the study participants within one month of their discharge.1 Based on the analysis, investigators concluded that two-thirds of patients who present to the hospital with pneumonia receive more antibiotics than they likely need.

The researchers noted that the problem does not generally involve the care patients receive in the hospital, but rather the prescriptions for antibiotics they receive upon discharge. Specifically, researchers found that 93% of the overly long antibiotic prescriptions they identified in their analysis were provided as patients were released from the hospital.

Investigators noted that antibiotic stewardship involves both choosing the right drug and the right duration. Their analysis suggests that providers should focus more attention on stewardship at the point of discharge. They also suggested that guidelines in this area should be clearer on how to calculate the right duration based on a patient’s condition.

In a press statement, the lead author of the study, Valerie Vaughn, MD, MSc, an assistant professor of internal medicine at the University of Michigan, indicated that national guidelines on the treatment of pneumonia are currently not very precise.2 Further, she noted that determining how long a patient should receive antibiotics typically depends on their diagnosis and how long it takes the patient to stabilize after treatment commences. In general, she noted that patients without risk factors require five days of treatment, while patients with risk factors or pneumonia caused by especially resistant bacteria require seven days of antibiotics.

In the study, patients identified with prescriptions that were overly long received two extra days of medication. Each extra day put the patients at risk for added side effects without any improvement in care. Indeed, these patients were 5% more likely to report an adverse effect, such as diarrhea, gastrointestinal distress, or a yeast infection.

Hospital performance regarding antibiotic prescriptions for this patient group varied. At some hospitals, roughly 50% of patients received prescription durations that were too long, while at other hospitals nearly all adult patients with pneumonia received longer prescriptions. Further, investigators reported that close to one-third of all prescriptions they reviewed were for fluoroquinolones, a class of strong antibiotics that pose added risks to the patient.

Researchers are working with the participating hospitals to investigate the issue further and chart a path toward improvement in this area. “We have a perfect opportunity to really improve antibiotic use for many patients,” Vaughn said. “If we can improve just one moment in time, that prescription patients get as they leave the hospital, we can eliminate nearly all unnecessarily prolonged treatment.”

REFERENCES

  1. Vaughn V, Flanders S, Snyder A, et al. Excess antibiotic treatment duration and adverse events in patients hospitalized with pneumonia: A multihospital cohort study. Ann Intern Med 2019; Jul 9. doi: 10.7326/M18-3640. [Epub ahead of print].
  2. Gavin K. Pneumonia patients get too many antibiotics – especially as they leave the hospital. University of Michigan Health Lab, July 9, 2019. Available at: http://bit.ly/2JWjCU3. Accessed July 26, 2019.