Antibiotic treatment of community acquired pneumonia varies widely across Germany.
Community Acquired Pneumonia (CAP) is a frequent and potentially fatal infectious disease which, in the majority of cases, needs an antibiotic intervention.


OBJECTIVE
Aim was to evaluate antibiotic treatment patterns regarding all types of mono- and combination-therapy throughout the local clinical centres (LCCs) represented in the German competence network CAPNETZ (=Community Acquired Pneumonia Network) and to identify clinical indicators for regional differences.


METHODS
We analysed outpatients and inpatients recruited between March 2003 and April 2005. Patient and treatment details were registered online using standardised data entry forms. A logistic regression model was issued for the 4 most frequently applied antibiotics, adjusting for potentially relevant confounders.


RESULTS
The study sample consisted of 3221 patients at the age of 18 to 102 years. Overall, aminopenicillins plus betalactamase inhibitor (20.4%), fluoroquinolone (17.0%), macrolides combined with cephalosporins third generation (10.6%) and cephalosporins third generation (8.9%) were most frequently prescribed. After control for potential confounders, significant treatment differences remained between study sites. Regional variability of antibiotic CAP-treatment could not be attributed to a number of clinical or sociodemographic factors.


CONCLUSIONS
The presented treatment variability ranges within given guidelines, but indicates the need for an ongoing implementation of evidence-based guidelines in order to avoid potential negative clinical or economic consequences.
Kohlhammer
Yvonne
Y
Institute of Social Medicine, Medical University Schleswig-Holstein, Campus Luebeck, Beckergrube 43-47, 23552 Luebeck, Germany. yvonne.kohlhammer@gsf.de
Raspe
Heiner
H
Marre
Reinhard
R
Suttorp
Norbert
N
Welte
Tobias
T
Schäfer
Torsten
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D005858:Germany; D006801:Humans; D018942:Macrolides / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D010818:Practice Patterns, Physicians'; D016896:Treatment Outcome; D047090:beta-Lactams / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones; D018942:Macrolides; D047090:beta-Lactams