title: Evaluation of empirical antibiotherapy for acute community-acquired pneumonia prescribed in emergency departments.
abstract: OBJECTIVE
  The authors assessed the management of community-acquired pneumonia (CAP) and empirical antibiotic prescription in a primary care center.
  
  
  METHODS
  A retrospective study was made on medical charts of patients admitted to the emergency department for CAP.
  
  
  RESULTS
  Seventy-six patients were included. Their mean age was 65years for a sex ratio of 1.81. Fever (83%) and cough (72%) were the most common symptoms. Chest X-ray was abnormal in 86%. The median CRP value was 138mg/L (58-235). The median Fine's score was 85.5 (60-127). Blood cultures were sterile for 82.5% of samples. Pneumococcal and legionella antigenuria were performed for 70% of patients, only one was positive for legionella. Antibiotherapy was prescribed to 18 patients before hospitalization. Amoxicillin-clavulanic acid was the most frequently prescribed empirical treatment (48.5%), followed by ceftriaxone (15%). The therapeutic adequation index was calculated at a median of 1.7 by three investigators (0-3.7). Kendall's concordance coefficient for the three investigators was good at 0.86 (P<0.0001). Close to 39% of antibiotic prescription had a bad therapeutic adequation index more than three.
  
  
  CONCLUSIONS
  Our clinical, radiological, and microbiological data was quite similar to reported data from teaching hospital series except for severity that seemed lower in primary care centers. The therapeutic adequation index is a useful tool to assess the adequacy of antibiotic prescription.
authors.affiliation: Court séjour gériatrique, Alès, France. dr.fraisse@ch-ales.fr
authors.forename: T
authors.initials: T
authors.lastname: Fraisse
authors.forename: G
authors.initials: G
authors.lastname: Fayad
authors.forename: C
authors.initials: C
authors.lastname: Jardy
authors.forename: A
authors.initials: A
authors.lastname: Sotto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D019468:Disease Management; D004363:Drug Utilization; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents