title: Poor compliance with community-acquired pneumonia antibiotic guidelines in a large Australian private hospital emergency department.
abstract: OBJECTIVE
  This study evaluated guideline concordance and time to administration of antibiotics in community-acquired pneumonia (CAP) in a private Australian emergency department (ED). Two key components in the management of CAP are timely administration and appropriate choice of antibiotic therapy. The use of antibiotics outside of guidelines can potentially increase rates of antibiotic resistance. Previous studies that evaluate guideline concordance have largely been conducted in Australian public hospitals; however, private hospitals comprise a significant portion of Australian health care.
  
  
  METHODS
  One hundred and thirty patients admitted to a private Brisbane hospital between 01/01/2011 and 28/03/2012 with an admission diagnosis of CAP were included. Data were collected on administration time and choice of antibiotic therapy in the ED. This was compared with local and national CAP guidelines.
  
  
  RESULTS
  Concordance with antibiotic guidelines was low (6.9%). Antibiotics with broader spectrum of action than that recommended in guidelines were frequently prescribed. Eighty-one percent of patients received their first antibiotic within 4 hours of arriving in the ED. Mortality was low at 0.9% in a cohort where 31% of patients were aged under 65.
  
  
  CONCLUSIONS
  We found low rates of concordance with CAP antibiotic guidelines and high use of broad-spectrum antibiotics. This has the potential to lead to increased rates of antibiotic resistance. A subtle alteration to the restrictions within the pharmaceutical benefit scheme formulary could potentially decrease the high usage of broad-spectrum antibiotics. However, the low mortality rate, nontoxic nature of these antibiotics, and the ease of their administration pose a challenge to convincing clinicians to alter their practice.
authors.affiliation: 1 Department of Medicine, Ipswich Hospital , Ipswich, Australia .
authors.forename: Helen L
authors.initials: HL
authors.lastname: Robinson
authors.forename: Philip C
authors.initials: PC
authors.lastname: Robinson
authors.forename: Michael
authors.initials: M
authors.lastname: Whitby
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001315:Australia; D017714:Community-Acquired Infections / Q000188:drug therapy*; D004352:Drug Resistance, Microbial / Q000187:drug effects; D004636:Emergency Service, Hospital; D017052:Hospital Mortality; D006760:Hospitalization; D016304:Hospitals, Private; D006801:Humans; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents