Evaluating Duration of Antimicrobial Therapy for Community-Acquired Pneumonia in Clinically Stable Patients

The Infectious Diseases Society of America guidelines for treatment of community-acquired pneumonia (CAP) recommend a minimum five-day course of antibiotics for patients who achieve clinical stability within 48 to 72 hours from initiation of appropriate therapy, though patients are often treated with a prolonged course of antibiotics. Methods: A retrospective chart review was conducted between January 1, 2015 and December 31, 2015 of all patients ≥ 18 years of age treated at Parkland Memorial Hospital to assess the percentage of hospitalized patients diagnosed with uncomplicated CAP receiving antimicrobial therapy in excess of the guideline-recommended duration, evaluate subsequent 30-day all-cause readmission rates, and determine if select co-morbidities influenced the length of antimicrobial therapy prescribed. Results: In eligible patients, 91.3% (178/195) received antimicrobial therapy in excess of the guideline recommended duration, with the average being 3.6 additional days. Mean length of stay (LOS) and duration of therapy were 2.3 (±1.6) days and 8.3 (±2.6) days, respectively. The 30-day all-cause readmission rate was 11.3% (22/195). The mean duration of therapy in the subgroup of patients requiring readmission was 7.8 (±2.2) days and was similar to the study average. Duration of therapy was not significantly affected by age, selected comorbidities (Pearson correlation coefficient 0.08, p=0.24), or LOS. Discussion: The majority of patients treated for CAP received durations of therapy exceeding national guideline recommendations resulting in a total of 645 excess days of antimicrobials. These results reveal potential opportunities for antimicrobial stewardship and provider education regarding duration of therapy for CAP which may help improve prescribing practices and decrease antimicrobial overuse.