title: Implication of clinical pathway care for community-acquired pneumonia in a community hospital: early switch from an intravenous beta-lactam plus a macrolide to an oral respiratory fluoroquinolone.
abstract: OBJECTIVE
  The effect of clinical pathway (CP) care and early switch from intravenous to oral antibiotics therapy on community-acquired pneumonia (CAP) has been well documented. However, limited studies have evaluated the effects of CP on reducing time taken for attaining clinical stability and duration of antibiotics prescriptions. This study was aimed to investigate the use of a CP and its implication for CAP in a community hospital.
  
  
  METHODS
  We conducted a retrospective cohort study of CAP patients hospitalized between November 2005 and January 2007. The patients were divided into two groups, those for whom CP was adopted and those for whom CP was not adopted on admission. We compared the outcomes of three risk classes assessed using the severity scoring system (A-DROP). CP included switching from an intravenous beta-lactam plus a macrolide to an oral respiratory fluoroquinolone, when the patients exhibited risk factors for drug-resistant pneumococci.
  
  
  RESULTS
  One hundred thirty-five patients were evaluated, and sixty received CP care. Patients in the CP group had a lower A-DROP score. Although clinical cure proportions were similar, the CP group in the mild and moderate classes (A-DROP score, <or=2) required significantly less time to achieve clinical stability and had a reduced duration of total antibiotics prescriptions, length of hospital stay, and hospital charges. These effects were absent in the severe class.
  
  
  CONCLUSIONS
  Implementation of this CP would lead to effective care, may serve to reduce time for attaining clinical stability and reduce the use of unnecessary antibiotics without worsening clinical outcomes in mild and moderate CAP.
authors.affiliation: Department of Respiratory Medicine, Nagoya University Graduate School of Medicine. yshindo@med.nagoya-u.ac.jp
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Shindo
authors.forename: Shinji
authors.initials: S
authors.lastname: Sato
authors.forename: Eiichi
authors.initials: E
authors.lastname: Maruyama
authors.forename: Takamasa
authors.initials: T
authors.lastname: Ohashi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ogawa
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Imaizumi
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Hasegawa
mesh_terms: D000280:Administration, Inhalation; D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy; D019091:Critical Pathways / Q000592:standards; D004359:Drug Therapy, Combination; D005260:Female; D024841:Fluoroquinolones / Q000008:administration & dosage*; D006764:Hospitals, Community / Q000379:methods* / Q000592:standards; D006801:Humans; D007262:Infusions, Intravenous; D018942:Macrolides / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D047090:beta-Lactams / Q000008:administration & dosage*
chemical_list: D024841:Fluoroquinolones; D018942:Macrolides; D047090:beta-Lactams