The Infectious Diseases Society of America (IDSA) guidelines remain the gold standard guidelines for infectious disease problems. The IDSA recommends treating patients with community-acquired pneumonia (CAP) for 5 days and it recommends treating those with healthcare-associated pneumonia (HCAP) for 7-8 days, even if they are hospitalized.
Despite these IDSA guidelines, many patients treated for CAP and HCAP receive antibiotics for a much longer duration despite reaching clinical stability. This study from 30 Veterans Affairs hospitals retrospectively assessed antibiotic duration in 1739 randomly selected, hospitalized patients with uncomplicated pneumonia. As many as 3 days of antibiotics beyond the recommended minimum number of days for CAP or HCAP was considered to be concordant with guidelines. Complicated pneumonia and nosocomial pneumonias were excluded from the study.
The study found that guideline-concordant antibiotic therapy was seen in only 7% of CAP patients and in only 29% of HCAP patients. The vast majority of patients received excessive antibiotics. Despite this, the mortality rates and hospital readmission rates were identical between guideline-concordant therapy and guideline-discordant therapy. Most of the excessive antibiotic use was after hospital discharge. Therefore, the emphasis should be on limiting antibiotics courses prescribed at the time of discharge.
There is now a big push nationally for improved antimicrobial stewardship by all facilities. This is one area where we can definitely decrease antibiotic use without any sacrifice in patient safety.
Madaras-Kelly KJ et al. Total duration of antimicrobial therapy in veterans hospitalized with uncomplicated pneumonia: Results of a national medication utilization evaluation. J Hosp Med 2016 Dec; 11:832.