MEDICATIONS: PATIENT FACTORS AND SITE OF CARE INFLUENCE ANTIBIOTIC PRESCRIPTION FOR PNEUMONIA

April 15, 2003 — Patient characteristics and the location of care were both factors that influenced the choice of antibiotic prescribed for patients with community-acquired pneumonia (CAP), according to an article in the April 14 issue of The Archives of Internal Medicine, a journal of the American Medical Association.

CAP is a common disease in North America that is caused by a bacterial infection and can lead to serious illness and death, according to the article. In about 50 percent of cases of CAP, the exact agent causing the pneumonia is unidentified, making prescribing the right antibiotic difficult. Choosing the right antibiotic is important because of the possibility of multidrug-resistant Streptococcus pneumoniae (the bacteria that causes CAP), and the fact that choosing a broad-spectrum antibiotic or misusing a specific antibiotic can result in antibiotic resistance or even death.

Christine Malcolm, B.Sc., and Thomas J. Marrie, M.D., of the University of Alberta, Edmonton, Canada studied the factors that influence the choice of antibiotic therapy for patients with CAP who were treated on an ambulatory basis (were not admitted) in an emergency department setting. The researchers studied 768 patients with CAP who visited one of 6 hospitals in the Capital Health Authority, Edmonton, Alberta, between Nov. 15, 2000 and April 30, 2001. The patients had an average age of 51 years.

The researchers report that the antibiotics most commonly prescribed were azithromycin (36 percent), levofloxacin (32 percent), and clarithromycin (17 percent). Site of care was associated with frequency of prescription of clarithromycin and levofloxacin.

Older age, presence of chronic obstructive pulmonary disease, currently receiving antibiotic therapy, and site of care were independently predictive of levofloxacin use.

The researchers also report that levofloxacin was inappropriately prescribed for 51 percent of the 245 patients treated with that particular antibiotic.