Excess antibiotic use for pneumonia associated with increase adverse events

1. In this retrospective cohort study, excess days of antibiotic treatment were not associated with reduced adverse outcomes.

2. Patients who took prolonged doses of antibiotics beyond the shortest recommended dose in guidelines reported a greater number of adverse events.

Evidence Rating Level: 2 (Good)

Study Rundown: Pneumonia affects a large proportion of patients each year and is a common reason for inpatient antibiotic use and overuse. The authors of this retrospective cohort study examined predictors and outcomes associated with excess duration of antibiotic treatment for pneumonia at 43 hospitals within the Michigan hospital Medicine Safety Consortium. The primary outcome examined was the rate of excess antibiotic treatment which was assessed by subtracting the shortest effective duration of antibiotics for the patient from the actual prescribed duration. Excess antibiotic treatment was associated with increased antibiotic-related adverse events without decrease in death, readmission, emergency department visits, or Clostridioides difficile infection. One of the study limitations was that based on the retrospective nature of this study, not all patients were able to be contacted to determine any 30-day outcomes.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Duration of Antibiotic Use Among Adults With Uncomplicated Community-Acquired Pneumonia Requiring Hospitalization in the United States

In-Depth [retrospective cohort study]: The authors conducted a retrospective cohort study from January 2017 to April 2018 assessing predictors and outcomes associated with excess duration of antibiotic treatment for pneumonia. A total of 7479 patients were eligible for inclusion, of which 6481 were included in the main analysis after inclusion and exclusion criteria were applied. Multivariable analyses were performed to determine predictors associated with rates of excess treatment duration and odds ratios (ORs) where reported to evaluate whether days of excess treatment were associated with adverse outcomes. Of the patients included, 67.8% of patients had excess antibiotic therapy. 73.2% had community acquired pneumonia and 26.8% had health care associated pneumonia. The authors observed that 67.8% of patients received antibiotics for longer than the shortest effective duration recommended by guidelines (71.8% [3410 of 4747] for CAP and 56.6% [981 of 1734] for HCAP). Excess duration of antibiotics was not associated with lower rates of adverse outcomes, which included death, emergency department visits and readmission. As well, the odds of a patient-reported adverse event were 5% (CI, 2% to 8%) greater for each day of excess antibiotic treatment.

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