The efficacy of an antibiotic protocol for community-acquired pneumonia.

Abstract

OBJECTIVE:

To assess the efficacy of an antibiotic protocol to avoid empirical use of third-generation cephalosporins in community-acquired pneumonia (CAP).

DESIGN AND SETTING:

Retrospective case review of patients with CAP one year after implementing the protocol. Comparison was made with patients with CAP treated at a metropolitan tertiary referral hospital (where use of third-generation cephalosporins was common).

PARTICIPANTS:

86 patients (district hospital with an antibiotic protocol) and 72 patients (metropolitan tertiary referral hospital), January - June 1999.

OUTCOME MEASURES:

Rate of staff adherence to the protocol; patient characteristics associated with poor protocol adherence; demographic and prognostic features of both groups at presentation; duration of intravenous therapy, time to defervescence, length of stay; inpatient mortality rates; and drug cost savings per patient treated according to the protocol.

RESULTS:

Overall protocol adherence rate was 60%. Patients with penicillin allergy were significantly less likely to receive treatment according to the protocol (P<0.001). At the district hospital, patients were generally older and taking more regular medications. Patients at each hospital had similar prognostic factors and demographic features at presentation. Inhospital mortality (P=0.92; 95% CI, -0.08 to 0.07), duration of fever (P=0.57) and length of stay (P=0.78) were not significantly different between patients treated empirically with penicillin and those treated empirically with third-generation cephalosporins. Treating a patient according to the protocol saved an average of $77.44 in drug costs.

CONCLUSION:

One year after implementation, our protocol for treating CAP is proving efficacious, although levels of adherence could improve.

• Authors: C J Dobbin, C J Duggan, D J Barnes
• Journal: The Medical journal of Australia (Med J Aust) Vol. 174 Issue 7 Pg. 333-7 (Apr 02 2001) ISSN: 0025-729X [Print] Australia
• PMID: 11346105 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Anti-Bacterial Agents
• Cephalosporins
• Penicillins
• Erythromycin
• Ampicillin
• Cefazolin
• Penicillin G

Topics

• Adult
• Aged
• Ampicillin (economics, therapeutic use)
• Anti-Bacterial Agents (economics, therapeutic use)
• Cefazolin (economics, therapeutic use)
• Cephalosporins (economics, therapeutic use)
• Clinical Protocols
• Community-Acquired Infections (diagnosis, drug therapy, economics, mortality)
• Cost-Benefit Analysis
• Drug Costs
• Drug Therapy, Combination
• Erythromycin (economics, therapeutic use)
• Female
• Hospital Mortality
• Humans
• Injections, Intravenous
• Male
• Middle Aged
• New South Wales
• Penicillin G (economics, therapeutic use)
• Penicillins (economics, therapeutic use)
• Pneumonia (diagnosis, drug therapy, economics, mortality)
• Prognosis
• Retrospective Studies
• Statistics, Nonparametric
• Treatment Outcome