Excess Antibiotic Therapy Causes Harm in Patients With Pneumonia

Antibiotic therapy duration is often too long and harmful for patients hospitalized with pneumonia, according to results of a new retrospective study.

To evaluate antibiotic duration and outcomes, the researchers reviewed data from 6481 patients with pneumonia from 43 hospitals in the Michigan Hospital Medicine Safety Consortium.

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The primary endpoint was excess treatment duration, which was defined as an antibiotic prescription lasting more than 30 days.

Logit generalized estimating equations were used to calculate rate ratios and evaluate patient outcomes at 30 days. Patient outcomes were identified via medical records or follow-up phone calls.

After analyzing the data, the researchers found that excess antibiotic therapy was prescribed to 4391 of 6481 patients (67.8%).

Patients who were more likely to receive excess therapy included those who had respiratory cultures or nonculture diagnostic testing, had a longer hospital stay, received a high-risk antibiotic in the prior 90 days, had community-acquired pneumonia, or did not have a total antibiotic treatment duration documented at discharge.

Moreover, excess antibiotic therapy was associated with an increased risk for antibiotic-associated adverse events after discharge. For every day of excess therapy, there was a 5% increased risk for an adverse event.

“Patients hospitalized with pneumonia often receive excess antibiotic therapy,” the researchers concluded. “Excess antibiotic treatment was associated with patient-reported adverse events. Future interventions should focus on whether reducing excess treatment and improving documentation at discharge improves outcomes.”

—Amanda Balbi

Reference:

Vaughn VM, Flanders SA, Snyder A, et al. Excess antibiotic treatment duration and adverse events in patients hospitalized with pneumonia: a multihospital cohort study [published online July 9, 2019]. Ann Intern Med. doi:10.7326/M18-3640.