Abstract
Pneumonia treatment guidelines mention that prior outpatient antibiotic treatment should be considered when planning inpatient antibiotic regime. Our aim was to study patterns of antibiotic prescribing at the outpatient to inpatient transition together with subsequent modifications during hospitalisation.
This is an observational study in a cohort of 1659 patients with pneumonia who after prior outpatient treatment were hospitalised in seven hospitals in the Netherlands (PHARMO) between 2005 and 2010. For each patient, we identified all prescribed antibiotics (ATC J01) prior to and during hospitalisation. The number and timing of modifications of antibiotic agent were assessed. A modification was defined as a change of agent or combination of agents.
The most prevalent outpatient treatments were amox/clav (39%), doxy (16%) and amox (14%), and 383 (23%) of the patients were prescribed the same agents as initial inpatient regime. Kaplan Meier curves showed differences in time to subsequent modification between patients with or without prior outpatient beta-lactam treatment and whether or not initial inpatient treatment included a beta-lactam antibiotic.
This study shows that inpatient treatment is modified in almost half of the patients with considerable variation in timing. In patients with prior outpatient beta-lactam treatment, the modification rate was the lowest if they were prescribed a non beta-lactam inpatient regime.
- © 2014 ERS
