title: Patterns of initial antibiotic therapy for community-acquired pneumonia in U.S. hospitals, 2000 to 2009.
abstract: BACKGROUND
  Although clinical guidelines for management of community-acquired pneumonia (CAP) in non-intensive care unit ("non-ICU") hospitalized patients have changed substantially over the last decade, it is unknown how treatment of this disease has evolved over this period.
  
  
  METHODS
  Using data from >100 U.S. hospitals, we identified all adults (aged ≥18 years) hospitalized for CAP between January 1, 2000, and June 30, 2009 ("study period"). We excluded patients admitted to ICU <24 hours of admission, those not starting antibiotics <24 hours of admission, those not receiving antibiotics for ≥48 hours (if alive), and those with probable healthcare-associated pneumonia. We defined "initial therapy" as all parenteral antibiotics received ≤24 hours of admission, and we examined changes in such therapy over the study period. The statistical significance of changes in initial therapy was ascertained using 2-tailed χ tests.
  
  
  RESULTS
  We identified 40,392 patients who met all selection criteria. In 2000, the most frequently used initial regimens were levofloxacin (24.0% of all such admissions), ceftriaxone (9.0%), cefotaxime (7.3%), ceftriaxone plus levofloxacin (3.2%) and azithromycin plus cefotaxime (3.0%); in 2009, they were ceftriaxone plus azithromycin (18.5%), levofloxacin (12.7%), ceftriaxone (6.6%), moxifloxacin (4.7%) and ceftriaxone + levofloxacin (3.2%). Use of single-agent regimens declined between 2000 and 2009 (from 48.2%-30.0%); use of vancomycin almost doubled (13.1%-23.3%). All findings were statistically significant (P < 0.01).
  
  
  CONCLUSIONS
  Initial antibiotic therapy for non-ICU CAP has changed substantially in the United States over the past decade, in line with evidence of widespread antibiotic resistance, evolving treatment guidelines and, most recently, quality improvement initiatives that tie hospital payments to guideline-based care.
authors.affiliation: Policy Analysis, Inc. (AB, JE, GO), Brookline, Massachusetts; Health Economics and Outcomes Research, Forest Research Institute, Inc. (XH), Jersey City, New Jersey; and Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine (DJW), Chapel Hill, North Carolina.
authors.forename: Ariel
authors.initials: A
authors.lastname: Berger
authors.forename: John
authors.initials: J
authors.lastname: Edelsberg
authors.forename: Gerry
authors.initials: G
authors.lastname: Oster
authors.forename: Xingyue
authors.initials: X
authors.lastname: Huang
authors.forename: David J
authors.initials: DJ
authors.lastname: Weber
mesh_terms: 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; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006761:Hospitals / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents