Management of community-acquired pneumonia: a focus on conversion from hospital to the ambulatory setting.
*Ambulatory Care; *Hospitalization; Anti-Bacterial Agents/*administration & dosage; Bacterial/*therapy; Community-Acquired Infections/therapy; Humans; Pneumonia
Patients with community-acquired pneumonia (CAP) are treated in hospital or in the ambulatory care setting depending on the severity of illness. Despite numerous guidelines proposed, there is no agreement on specific criteria for hospitalization other than the clinicians' experience. The purpose of this review is to discuss the importance of the appropriate choice and timely administration of antibacterial agents, either in the hospital or in the outpatient setting. Since a high proportion of CAP patients will not have an etiologic agent identified at the time of initiation of treatment, the choice of antibacterial therapy is usually empiric. Antibacterial agents with activity against pneumococci and atypical pathogens causing pneumonia are the preferred choices. Macrolides, doxycycline, or respiratory fluoroquinolones have been recommended by various guidelines committees in North America for the treatment of pneumonia in patients with or without underlying comorbidities. Because of the increasing resistance to beta-lactams as well other antibacterial agents such as macrolides, doxycycline, and sulfamethoxazole/trimethoprim (cotrimoxazole), it is important that clinicians are aware of local statistics on resistance to Streptococcus pneumoniae, as infection with this bacterium is associated with high rates of morbidity and mortality. More recently, fluoroquinolone resistance has been reported, but the percentage of pneumococcal strains resistant to this agent is relatively low compared with the other antibacterial agents. Switch (intravenous to oral) therapy is recommended for hospitalized patients with CAP to facilitate early discharge, which has been shown to improve patient satisfaction and reduce hospital costs. Early conversion to oral therapy has not been shown to be associated with increased complications or higher mortality. Following prompt intravenous therapy and stabilization, patients with CAP should be treated with oral therapy in the ambulatory setting.
Tan James S; File Thomas M Jr
American journal of respiratory medicine : drugs, devices, and other interventions
2003
1905-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/bf03256666" target="_blank" rel="noreferrer noopener">10.1007/bf03256666</a>
Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011.
Adolescence; Adolescent; Adult; Aged; Ambulatory Care – Statistics and Numerical Data; Ambulatory Care/*statistics & numerical data; Anti-Bacterial Agents/*therapeutic use; Antibiotics – Therapeutic Use; Child; Female; Health Care Surveys; Human; Humans; Inappropriate Prescribing – Statistics and Numerical Data; Inappropriate Prescribing/*statistics & numerical data; Infant; Male; Middle Age; Middle Aged; Newborn; Otitis Media; Otitis Media – Drug Therapy; Pharyngitis – Drug Therapy; Pharyngitis/drug therapy; Physicians'/*statistics & numerical data; Practice Patterns; Preschool; Prevalence; Respiratory Tract Infections – Drug Therapy; Respiratory Tract Infections/drug therapy; Suppurative/*drug therapy; Surveys; United States
IMPORTANCE: The National Action Plan for Combating Antibiotic-Resistant Bacteria set a goal of reducing inappropriate outpatient antibiotic use by 50% by 2020, but the extent of inappropriate outpatient antibiotic use is unknown. OBJECTIVE: To estimate the rates of outpatient oral antibiotic prescribing by age and diagnosis, and the estimated portions of antibiotic use that may be inappropriate in adults and children in the United States. DESIGN, SETTING, AND PARTICIPANTS: Using the 2010-2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, annual numbers and population-adjusted rates with 95% confidence intervals of ambulatory visits with oral antibiotic prescriptions by age, region, and diagnosis in the United States were estimated. EXPOSURES: Ambulatory care visits. MAIN OUTCOMES AND MEASURES: Based on national guidelines and regional variation in prescribing, diagnosis-specific prevalence and rates of total and appropriate antibiotic prescriptions were determined. These rates were combined to calculate an estimate of the appropriate annual rate of antibiotic prescriptions per 1000 population. RESULTS: Of the 184,032 sampled visits, 12.6% of visits (95% CI, 12.0%-13.3%) resulted in antibiotic prescriptions. Sinusitis was the single diagnosis associated with the most antibiotic prescriptions per 1000 population (56 antibiotic prescriptions [95% CI, 48-64]), followed by suppurative otitis media (47 antibiotic prescriptions [95% CI, 41-54]), and pharyngitis (43 antibiotic prescriptions [95% CI, 38-49]). Collectively, acute respiratory conditions per 1000 population led to 221 antibiotic prescriptions (95% CI, 198-245) annually, but only 111 antibiotic prescriptions were estimated to be appropriate for these conditions. Per 1000 population, among all conditions and ages combined in 2010-2011, an estimated 506 antibiotic prescriptions (95% CI, 458-554) were written annually, and, of these, 353 antibiotic prescriptions were estimated to be appropriate antibiotic prescriptions. CONCLUSIONS AND RELEVANCE: In the United States in 2010-2011, there was an estimated annual antibiotic prescription rate per 1000 population of 506, but only an estimated 353 antibiotic prescriptions were likely appropriate, supporting the need for establishing a goal for outpatient antibiotic stewardship.
Fleming-Dutra Katherine E; Hersh Adam L; Shapiro Daniel J; Bartoces Monina; Enns Eva A; File Thomas M Jr; Finkelstein Jonathan A; Gerber Jeffrey S; Hyun David Y; Linder Jeffrey A; Lynfield Ruth; Margolis David J; May Larissa S; Merenstein Daniel; Metlay Joshua P; Newland Jason G; Piccirillo Jay F; Roberts Rebecca M; Sanchez Guillermo V; Suda Katie J; Thomas Ann; Woo Teri Moser; Zetts Rachel M; Hicks Lauri A
JAMA
2016
2016-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1001/jama.2016.4151" target="_blank" rel="noreferrer noopener">10.1001/jama.2016.4151</a>