title: Appropriate antibiotic utilization in seniors prior to hospitalization for community-acquired pneumonia is associated with decreased in-hospital mortality.
abstract: BACKGROUND
  We analysed the association of mortality and prescription of antibiotics prior to hospitalization for community-acquired pneumonia.
  
  
  METHODS
  We used administrative data (hospital abstracts, physician claims, prescriptions) for seniors (age 61 years and over) for Alberta, Canada from 1 April 1994 to 31 March 1999.
  
  
  RESULTS
  Hospitalization of 21 191 seniors occurred during the study period. In about 43% of hospitalizations (n = 9034), a physician was consulted prior to hospital admission. Antibiotics were dispensed to 31% of those with a prior physician visit and in about 72%, the antibiotic choice was deemed appropriate. The odds for mortality were significantly decreased in those with prior physician visits (OR = 0.87, P < 0.01), with any antibiotic prescription (OR = 0.66, P < 0.0001), and with an appropriate antibiotic (OR = 0.68, P = 0.03). The choice of an appropriate antibiotic as opposed to an inappropriate antibiotic resulted in a 2.6% absolute and 38% relative mortality reduction.
  
  
  CONCLUSIONS
  Choosing an appropriate outpatient antibiotic in accordance with published expert opinion guidelines compared with inappropriate antibiotic prescriptions decreased hospital mortality in patients subsequently hospitalized for community-acquired pneumonia.
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. cujecjohnson@shaw.ca
authors.forename: D
authors.initials: D
authors.lastname: Johnson
authors.forename: K C
authors.initials: KC
authors.lastname: Carriere
authors.forename: Y
authors.initials: Y
authors.lastname: Jin
authors.forename: T
authors.initials: T
authors.lastname: Marrie
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods; D017291:Clarithromycin / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D015897:Comorbidity; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data; D004363:Drug Utilization; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011014:Pneumonia / Q000175:diagnosis / Q000628:therapy; D011314:Preventive Health Services / Q000379:methods; D012189:Retrospective Studies; D013420:Sulfamethoxazole / Q000627:therapeutic use; D015996:Survival Rate; D014295:Trimethoprim / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014295:Trimethoprim; D017291:Clarithromycin; D013420:Sulfamethoxazole