title: Antibiotic prescribing on admission to patients with pneumonia and prior outpatient antibiotic treatment: a cohort study on clinical outcome.
abstract: OBJECTIVE
  Most pneumonia treatment guidelines recommend that prior outpatient antibiotic treatment should be considered when planning inpatient antibiotic regimen. Our purpose was to study in patients admitted for community-acquired pneumonia the mode of continuing antibiotic treatment at the outpatient to inpatient transition and the subsequent clinical course.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Dutch PHARMO Record Linkage System.
  
  
  METHODS
  7323 patients aged >18 years and hospitalised with pneumonia in the Netherlands between 2004 and 2010.
  We identified all prescribed antibiotics prior to, during and after hospitalisation. In case of prior outpatient treatment, the continuation of antibiotic treatment on admission was categorised as: no atypical coverage > no atypical coverage; atypical coverage > atypical coverage; no atypical coverage > atypical coverage; and atypical coverage > no atypical coverage.
  
  
  METHODS
  Length of hospital stay, in-hospital mortality and readmission within 30 days.
  
  
  RESULTS
  Twenty-two per cent of the patients had received prior outpatient treatment, of which 408 (25%) patients were switched on admission to antibiotics with atypical coverage. There were no differences in length of hospital stay, in-hospital mortality or readmission rate between the four categories of patients with prior outpatient treatment. The adjusted HR for adding atypical coverage versus no atypical coverage was 0.91 (95% CI 0.55 to 1.51) for time to discharge. For in-hospital mortality and readmission within 30 days, the adjusted ORs were 1.09 (95% CI 0.85 to 1.34) and 0.59 (95% CI 0.30 to 1.18), respectively.
  
  
  CONCLUSIONS
  This study found no association between mode of continuing antibiotic treatment at the outpatient to inpatient transition and relevant clinical outcomes. In particular, adding atypical coverage in patients without prior atypical coverage did not influence the outcome.
authors: Department of Clinical Pharmacy, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands Divison of Pharmacoepidemiology & Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
authors: Ewoudt M W
authors: EM
authors: van de Garde
authors: Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Stephanie
authors: S
authors: Natsch
authors: Divison of Infectious Diseases, Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors: Jan M
authors: JM
authors: Prins
authors: Department of Clinical Pharmacy, Tergooi Hospital, Hilversum/Blaricum, The Netherlands PHARMO, Institute for Drug Outcomes Research, Utrecht, The Netherlands.
authors: Paul D
authors: PD
authors: van der Linden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002985:Clinical Protocols; D011307:Drug Prescriptions; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016017:Odds Ratio; D010343:Patient Admission; D010359:Patient Readmission; D011014:Pneumonia / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: CLINICAL PHARMACOLOGY; EPIDEMIOLOGY