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National Study of Antibiotic Use in Emergency Department Visits for Pneumonia, 1993 Through 2008
Author(s) -
Neuman Mark I.,
Ting Sarah A.,
Meydani Ahou,
Mansbach Jonathan M.,
Camargo Carlos A.
Publication year - 2012
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2012.01342.x
Subject(s) - medicine , emergency department , pneumonia , guideline , antibiotics , confidence interval , community acquired pneumonia , ambulatory , penicillin , emergency medicine , pediatrics , pathology , psychiatry , microbiology and biotechnology , biology
ACADEMIC EMERGENCY MEDICINE 2012; 19: 562–568 © 2012 by the Society for Academic Emergency Medicine Abstract Objectives: The Infectious Disease Society of America (IDSA) and American Thoracic Society (ATS) developed guidelines for the management of community‐acquired pneumonia (CAP); however, there are sparse data on actual rates of antibiotic use in the emergency department (ED) setting. Methods: Data were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for ED visits during 1993 through 2008 for adults with a diagnosis of pneumonia. Results: During the study period there were an estimated 23,252,000 pneumonia visits, representing 1.8% of all ED visits. The visit rate for pneumonia during this 16‐year period may have increased (p trend = 0.055). Overall, 66% of adult patients with a primary diagnosis of pneumonia had documentation of an antibiotic administered while in the ED. There was an increase in antibiotic administration for adults with pneumonia from 1993 through 2008 (49% to 80%; p trend < 0.001). Specifically, there was an increase in use of macrolides from 1993 to 2006 (20% to 30%, p trend < 0.001) and a marked increase in use of quinolones from 0% to 39% from 1993 through 2008 (p trend < 0.001). Penicillin and cephalosporin use remained stable. Use of an antibiotic consistent with 2007 IDSA/ATS guidelines increased from 22% (95% confidence interval [CI] = 16% to 27%) of cases in 1993–1994 to 68% (95% CI = 63% to 73%) of cases in 2007–2008 (p trend < 0.001). Conclusions: ED visit rates for pneumonia increased slightly from 1993 through 2008. Although antibiotic administration in the ED has increased for adults with CAP, guideline‐concordant antibiotics may not be consistently administered.