The efficacy of an antibiotic protocol for community-acquired pneumonia.
OBJECTIVE
To assess the efficacy of an antibiotic protocol to avoid empirical use of third-generation cephalosporins in community-acquired pneumonia (CAP).


METHODS
Retrospective case review of patients with CAP one year after implementing the protocol. Comparison was made with patients with CAP treated at a metropolitan tertiary referral hospital (where use of third-generation cephalosporins was common).


METHODS
86 patients (district hospital with an antibiotic protocol) and 72 patients (metropolitan tertiary referral hospital), January - June 1999.


METHODS
Rate of staff adherence to the protocol; patient characteristics associated with poor protocol adherence; demographic and prognostic features of both groups at presentation; duration of intravenous therapy, time to defervescence, length of stay; inpatient mortality rates; and drug cost savings per patient treated according to the protocol.


RESULTS
Overall protocol adherence rate was 60%. Patients with penicillin allergy were significantly less likely to receive treatment according to the protocol (P<0.001). At the district hospital, patients were generally older and taking more regular medications. Patients at each hospital had similar prognostic factors and demographic features at presentation. Inhospital mortality (P=0.92; 95% CI, -0.08 to 0.07), duration of fever (P=0.57) and length of stay (P=0.78) were not significantly different between patients treated empirically with penicillin and those treated empirically with third-generation cephalosporins. Treating a patient according to the protocol saved an average of $77.44 in drug costs.


CONCLUSIONS
One year after implementation, our protocol for treating CAP is proving efficacious, although levels of adherence could improve.
Dobbin
C J
CJ
Royal Prince Alfred Hospital, Sydney, NSW.
Duggan
C J
CJ
Barnes
D J
DJ
D000328:Adult; D000368:Aged; D000667:Ampicillin / Q000191:economics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D002437:Cefazolin / Q000191:economics / Q000627:therapeutic use; D002511:Cephalosporins / Q000191:economics / Q000627:therapeutic use*; D002985:Clinical Protocols; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004359:Drug Therapy, Combination; D004917:Erythromycin / Q000191:economics / Q000627:therapeutic use; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010400:Penicillin G / Q000191:economics / Q000627:therapeutic use; D010406:Penicillins / Q000191:economics / Q000627:therapeutic use*; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins; D004917:Erythromycin; D000667:Ampicillin; D002437:Cefazolin; D010400:Penicillin G