Obstacles to penicillin use in treating pneumococcal infection.
OBJECTIVE
To determine the pattern of penicillin use in the treatment of pneumococcal pneumonia, and factors contributing to the use of alternative antibiotics.


METHODS
This study included all adult inpatients of St. Vincent's Hospital and Medical Center who had documented pneumococcal pneumonia between December 1998 and October 1999. St. Vincent's is a 600 bed tertiary teaching hospital in New York City. Patients who had Streptococcus pneumoniae isolated from a respiratory tract specimen were identified through microbiology laboratory records. A retrospective chart review of these patients was conducted, and those identified with clinical pneumonia were included in this study. Antibiotic use, patient demographics, resistance data, and clinician awareness of the antibiotic susceptibility results were noted.


RESULTS
Sixty adult patients hospitalized with documented pneumococcal pneumonia were identified. Thirteen (21.6%) of the 60 patients received penicillin or ampicillin. Susceptibility results were not noted in the medical record in 21 (35.0%) of the 60 patients, and none received penicillin. High rates of reported penicillin allergy in 8 (13.3%) of the 60 patients, and reluctance to use penicillin when isolates demonstrated intermediate susceptibility in 8 (13.3%) of the 60 patients were observed.


CONCLUSIONS
Several remediable obstacles to penicillin use were identified in this study. An increased awareness of susceptibility results by physicians and education of practitioners could have increased the use of penicillin as therapy to two-thirds of these patients.
Nord
J A
JA
Section of Infectious Diseases, Department of Medicine, St. Vincent's Hospital and Medical Center, New York, New York 10011, USA. jillanord@aol.com
LaBombardi
V J
VJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000667:Ampicillin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010400:Penicillin G / Q000009:adverse effects / Q000627:therapeutic use*; D010403:Penicillin Resistance; D010406:Penicillins / Q000009:adverse effects / Q000627:therapeutic use*; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy*; D012307:Risk Factors
D010406:Penicillins; D000667:Ampicillin; D010400:Penicillin G