Two-thirds of pneumonia patients receive more antibiotics than they probably need

A million times a year, pneumonia sends American adults to the hospital. And while antibiotics help save lives, a new study shows that two-thirds get more antibiotics than they probably need.

The study reveals that it is not the care provided at the hospital that leads to excessive treatment. Rather, it is the prescriptions that patients receive from the hospital when they return home.

In total, 93% of the long antibiotics prescribed to patients with pneumonia were written at the exit of the hospital.

Additional doses of antibiotics have a physical cost. The greater the number of antibiotics received by a patient beyond the recommended minimum daily, the greater the risk that they will be exposed to medication-related problems, such as stomach upset or yeast infections, is high.

The results come from detailed medical records of nearly 6,500 pneumonia patients treated in 43 Michigan hospitals and telephone conversations with 60% of them less than a month after their stay at the hospital. hospital. The results are published in the Annals of Internal Medicine.

The badysis, led by researchers at the University of Michigan, suggests that hospitals have a major opportunity to prescribe prescriptions of antibiotics at the appropriate size for patients on leave pneumonia who leave. The team behind the study, the Michigan Hospital's Hospital Safety Consortium, is already working to help Michigan hospitals do it.

Antibiotic management, which includes the choice of the right drug and the appropriate duration for each patient, has become an integral part of most hospitals. But these results show us that we need to pay more attention to management at the exit – and suggest that guidelines for prescribers be clearer on how to calculate an appropriate duration depending on the status of the patient. patient. "

Valerie Vaughn, M.D., M.Sc., lead author of the new article, Assistant Professor of Internal Medicine at U-M

Vaughn is a hospitalist, a type of physician specializing in inpatient care, as well as a researcher in the field of health care and patient safety.

She noted that national guidelines for treating pneumonia were not specific.

Determining how many days of antibiotics a patient needs from pneumonia depends on his diagnosis and the time it took for stabilization after the start of treatment. But in general, most patients without risk factors require about five days of treatment, and those with risk factors or pneumonia caused by a particularly resistant bacterium require about seven days.

The study shows that most patients who have been prescribed an antibiotic too long have taken two extra days of pills; and that every additional day puts patients at risk for side effects without improving care.

Hospitals have varied considerably in the percentage of their pneumonia patients who have received too much antibiotics. In some hospitals, less than 50% had, but in others almost all patients had.

Half of the antibiotics prescribed to patients in the study came from prescriptions written out of the hospital. Nearly one-third of them involved fluoroquinolones, a potent group of antibiotics with special risks ranging from prophylaxis to "superbugs" infections to torn tendons and ruptured arteries. Vaughn and his colleagues have previously studied the fluoroquinolone prescription in Michigan hospital patients.

Patients in the new study who received an excess of antibiotics did not have better results from their pneumonia. But for each additional day of antibiotics they received, they were 5% more likely to report an adverse event. These included diarrhea, gastrointestinal distress and yeast infections.

Some factors seemed to play a role in which patients received too long antibiotic prescriptions. The longer a person stayed in the hospital for a long time, the more likely they were to receive a prescription for extra long antibiotics. If they had a test to determine the type of bacteria through which their lungs were infected, they also risked being treated too long.

University hospitals had lower rates of excessive prescribing of antibiotics -; perhaps because they have more resources for stewardship programs. But staff in these programs may not have access to drug treatment records, notes Vaughn.

Vaughn and colleagues at the Michigan Hospital Drug Safety Consortium are continuing to study the problem and are working on improving hospitals.

"We have an excellent opportunity to actually improve the use of antibiotics for many patients.If we can improve a single moment in time, that prescription patients get when they leave the hospital. In hospital, we can eliminate almost any prolonged treatment unnecessarily, "she says.