National study of antibiotic use in emergency department visits for pneumonia, 1993 through 2008.
Acad Emerg Med. 2012 May;19(5):562-8
Authors: Neuman MI, Ting SA, Meydani A, Mansbach JM, Camargo CA
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.
PMID: 22594360 [PubMed - in process]