It does not take lung, I mean long for a study on choosing the appropriate antibiotic for presumptive bacterial pneumonia to get your attention and this week, we share two such studies—one dealing with antibiotic selection in the setting of a community-acquired pneumonia (CAP), and one focused on inpatient pneumonia.
The first of these studies by Handy et al. (10.1542/peds.2016-2331) compared guideline recommendations for amoxicillin being first-line for community-acquired pneumonia with what is actually done within a large outpatient primary care network involving more than 10,000 pediatric patients seen from 2009-2013. Sadly, only 40.7% of patients got amoxicillin with 42% getting macrolides and 16.8% getting broad spectrum antibiotics. Unfortunately, the factors that led to the use of an antimicrobial other than amoxicillin involved factors unrelated to the underlying potential bacterial pathogen. To find out what is driving variability in choice of antibiotic, read this study in detail and see if some of those factors are influencing your choice as well and what you might do differently as a result.
The second of these studies by Williams et al. (10.1542/peds.2016-3231) again compared a national evidence-based guideline with what actually is prescribed at 28 children’s hospitals over a 6-year period (2009-2015) taking into account pre- and post-choices around the guideline being implemented in 2011. In this case a guideline made a difference with increased prescribing of penicillins (recommended as first line for in-hospital pneumonia). Local efforts to implement the guideline on various units seemed to make the most difference in who had the greatest increases in appropriate use of penicillins.
The need to be a local champion to promote the dissemination of evidence-based guidelines in both the in-and outpatient setting is easier said than done. To help guide us in reducing the variability and increasing the adherence to guideline recommendations for treatment of pneumonia, infectious disease specialists Drs. Adam Hersh and Matthew Kronman offer a commentary on what we can do to prescribe more appropriate antibiotics for CAP if such drugs are needed in our patients. The need to prescribe the right antibiotic while being judicious with their use is an easy pill to swallow made easier by reading both studies and commentary on this important topic.