Drug usage evaluation of antimicrobial therapy for community-acquired pneumonia

Abstract

Aim: To review antimicrobial therapy of community-acquired pneumonia (CAP) at the Princess Alexandra Hospital and compare management with institutional guidelines. Method: Clinical pharmacists prospectively reviewed 100 patients with a diagnosis of CAP during a five-week period in August and September 1998. Clinical and laboratory data were collected from patient records and assessed for compliance with institutional guidelines for the appropriate management of CAP. For the purposes of these guidelines, pneumonia severity was defined according to the clinical condition of the patient and their inherent risk factors. Results: Ninety-nine patients (99%) were prescribed an antibiotic for the treatment of CAP. Ninety-six patients were prescribed parenteral antibiotics for a mean of 7 days (range 0-27 days, median 6 days). Seventy-six patients were prescribed oral therapy for a mean duration of 10 days (range 3-21 days, median 9 days). Only 11 of 41 patients (27%) with severe pneumonia received IV erythromycin. Thirteen of 28 patients (46%) diagnosed with mild-moderate pneumonia were inappropriately treated with broad-spectrum parenteral agents. Only 45% of patients were treated appropriately. Thirty-three positive sputum cultures were reported (from 54 specimens) and four patients returned more than one isolate. Fourteen per cent of the patients admitted with CAP died during their admission. Conclusions: Community-acquired pneumonia is a major cause of death due to infection. This study showed an under-utilisation of parenteral antibiotics for severe pneumonia and an overuse of broad-spectrum parenteral antibiotics for moderate pneumonia without co-morbidities. New pneumonia management guidelines have been developed and a further review was recently undertaken in an attempt to reduce inappropriate management of CAP within our institution.