Antibiotics Within Four Hours for Pneumonia Not Feasible

Study suggests that criteria may include cases in which antibiotics unnecessary

THURSDAY, March 8 (HealthDay News) -- The recommendation that emergency department patients with suspected pneumonia receive antibiotics within four hours may not be feasible since only about 65 percent of patients receive antibiotics in time, according to study findings published online in the Annals of Emergency Medicine. What's more, the practice may mean that many patients are treated with antibiotics unnecessarily.

Christopher Fee, M.D., and Ellen J. Weber, M.D., from the University of California San Francisco Medical Center, assessed whether 152 randomly chosen patients received antibiotics within four hours of being seen in an emergency department in 2005. All patients met the Joint Commission on Accreditation of Healthcare Organization/Centers for Medicare and Medicaid Services (JCAHO/CMS) community-acquired pneumonia core measures criteria.

The researchers found that 34.9 percent of patients did not receive antibiotics within four hours ("outliers"), of whom more than half did not have a final hospital discharge diagnosis of community-acquired pneumonia. Therefore, they estimated that at least 20.4 percent of eligible patients did not have a diagnosis of pneumonia. Of the outliers who were not diagnosed with community-acquired pneumonia, 43.3 percent had an abnormal chest x-ray, compared with 95 percent of those diagnosed with pneumonia.

"It may not be possible to identify 90 percent of hospitalized patients with a discharge diagnosis of community-acquired pneumonia during their emergency department assessment by using the current JCAHO/CMS criteria," Fee and Weber conclude. "A more realistic performance standard for antibiotic administration should be established or case definitions modified to include only patients with a final emergency department community-acquired pneumonia diagnosis or objective clinical and radiographic evidence."

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