title: Total duration of antimicrobial therapy in veterans hospitalized with uncomplicated pneumonia: Results of a national medication utilization evaluation.
abstract: Practice guidelines recommend the shortest duration of antimicrobial therapy appropriate to treat uncomplicated pneumonia be prescribed to reduce the emergence of resistant pathogens. A national evaluation was conducted to assess the duration of therapy for pneumonia.
  
  
  
  Retrospective medication utilization evaluation.
  
  
  
  Thirty Veterans Affairs medical centers.
  
  
  
  Inpatients discharged with a diagnosis of pneumonia.
  
  
  
  A manual review of electronic medical records of inpatients discharged with uncomplicated community-acquired pneumonia (CAP) or healthcare-associated pneumonia (HCAP) was conducted. Appropriate CAP therapy duration was defined as at least 5 days, and up to 3 additional days beginning the first day the patient achieved clinical stability criteria; the appropriate HCAP therapy duration was defined as 8 days. The duration of antimicrobial therapy for intravenous (IV) and oral (PO) inpatient administration, PO therapy dispensed upon discharge, Clostridium difficile infection (CDI), hospital readmission, and death rates were measured.
  
  
  
  Of 3881 pneumonia admissions, 1739 met inclusion criteria (CAP [n = 1195]; HCAP [n = 544]). Overall, 13.9% of patients (CAP [6.9%], HCAP [29.0%]) received therapy duration consistent with guideline recommendations. The median (interquartile range) days of therapy were 4 days (3-6 days), 1 day (0-3 days), and 6 days (4-8 days) for inpatient IV, inpatient PO, and outpatient PO antimicrobials, respectively. CDI was rare but more common in patients who received therapy duration consistent with guidelines. Therapy duration was not associated with the readmission or mortality rate.
  
  
  
  Antimicrobials were commonly prescribed for a longer duration than guidelines recommend. The majority of excessive therapy was completed upon discharge, identifying the need for strategies to curtail unnecessary use postdischarge. Journal of Hospital Medicine 2015;11:832-839. © 2015 Society of Hospital Medicine.
authors.affiliation: Pharmacy Service, Veterans Affairs Medical Center and Department of Pharmacy Practice, College of Pharmacy, Idaho State University, Meridian, Idaho.
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Madaras-Kelly
authors.affiliation: Center for Medication Safety, Hines VA, Hines, Illinois.|VA Pharmacy Benefits Management Services, Hines VA, Hines, Illinois.
authors.forename: Muriel
authors.initials: M
authors.lastname: Burk
authors.affiliation: Pharmacy Service, Veterans Affairs Medical Center, Boise, Idaho.
authors.forename: Christina
authors.initials: C
authors.lastname: Caplinger
authors.affiliation: Pharmacy Service, Veterans Affairs Medical Center, Boise, Idaho.
authors.forename: Jefferson G
authors.initials: JG
authors.lastname: Bohan
authors.affiliation: VA Pharmacy Benefits Management Services, Hines VA, Hines, Illinois.
authors.forename: Melinda M
authors.initials: MM
authors.lastname: Neuhauser
authors.affiliation: Infectious Diseases Section, VA Greater Los Angeles Health Care System and David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California.
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
authors.affiliation: Center for Medication Safety, Hines VA, Hines, Illinois.
authors.forename: Rongping
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Center for Medication Safety, Hines VA, Hines, Illinois.|VA Pharmacy Benefits Management Services, Hines VA, Hines, Illinois.
authors.forename: Francesca E
authors.initials: FE
authors.lastname: Cunningham
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy*; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006760:Hospitalization; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000188:drug therapy*; D012189:Retrospective Studies; D013997:Time Factors; D014728:Veterans
chemical_list: D000890:Anti-Infective Agents