AI Article Synopsis
- This study evaluated how antibiotics are prescribed for outpatient community-acquired pneumonia (CAP) in U.S. adults, finding that broad-spectrum antibiotics are still frequently used despite guidelines recommending otherwise.
- From 2008 to 2019, the use of broad-spectrum antibiotics decreased significantly among both healthy patients and those with comorbidities, but more than a third of each group still received them.
- Factors such as age, geographic region, and healthcare provider specialty influenced the prescription patterns of these antibiotics.
Article Abstract
Purpose: To characterize antibiotic utilization for outpatient community-acquired pneumonia (CAP) in the United States.
Methods: We conducted a cohort study among adults 18-64 years diagnosed with outpatient CAP and a same-day guideline-recommended oral antibiotic fill in the MarketScan® Commercial Database (2008-2019). We excluded patients coded for chronic lung disease or immunosuppressive disease; recent hospitalization or frequent healthcare exposure (e.g., home wound care, patients with cancer); recent antibiotics; or recent infection. We characterized utilization of broad-spectrum antibiotics (respiratory fluoroquinolone, β-lactam + macrolide, β-lactam + doxycycline) versus narrow-spectrum antibiotics (macrolide, doxycycline) overall and by patient- and provider-level characteristics. Per 2007 IDSA/ATS guidelines, we stratified analyses by otherwise healthy patients and patients with comorbidities (coded for diabetes; chronic heart, liver, or renal disease; etc.).
Results: Among 263 914 otherwise healthy CAP patients, 35% received broad-spectrum antibiotics (not recommended); among 37 161 CAP patients with comorbidities, 44% received broad-spectrum antibiotics (recommended). Ten-day antibiotic treatment durations were the most common for all antibiotic classes except macrolides. From 2008 to 2019, broad-spectrum antibiotic use substantially decreased from 45% to 19% in otherwise healthy patients (average annual percentage change [AAPC], -7.5% [95% CI -9.2%, -5.9%]), and from 55% to 29% in patients with comorbidities (AAPC, -5.8% [95% CI -8.8%, -2.6%]). In subgroup analyses, broad-spectrum antibiotic use varied by age, geographic region, provider specialty, and provider location.
Conclusions: Real-world use of broad-spectrum antibiotics for outpatient CAP declined over time but remained common, irrespective of comorbidity status. Prolonged duration of therapy was common. Antimicrobial stewardship is needed to aid selection according to comorbidity status and to promote shorter courses.
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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11016291 | PMC |
| http://dx.doi.org/10.1002/pds.5779 | DOI Listing |
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