Pneumonia is the fifth leading caus...

Pneumonia is the fifth leading cause of death in the United States in patients older than 65 years. It also is undivided of the more common reasons for hospitalizing patients in this age clump Multiple studies have shown that timely administration of antibiotics to patients admitted for treatment of pneumonia improves survival. newly come published guidelines from two organizations have commended that patients admitted with community-acquired pneumonia (CAP) receive the first dose of antibiotics within eight hours of admission. undivided of these studies found that the relationship between early antibiotic administration and survival was stronger when patients who had received prehospitalization antibiotics were exclud from the analysis. Houck and colleagues assessed the relationship between the timing of the first antibiotic dose and mortality, amplification of stay, and readmission rates in patients older than 65 years who were hospitalized for CAP. In particular, they evaluated solitary those patients who had not received any antibiotic treatment before admission to the hospital.

The meditation was a retrospective chart analysis of a randomized national sample of Medicare patients. The investigation was a part of the National Pneumonia delineate which used fee-for-service hospital claims to identify charts that would be included in the reflection A random sample of up to 850 charts through state was established, and abstractors used a computerized tool to record patient demographics and time until the first dose of antibiotics. Death and readmission data were assembleed from the Medicare enrollment database and Part A claims. Patients were exclud from the subject of attention if they did not have radiographic evidence of pneumonia, if there was no documentation of first antibiotic dose timing, if they were immunocompromised, if they did not receive antibiotic therapy within 36 hours of admission, or if they were discharged or died forward the day of admission. Main issues included severity-adjusted mortality, readmissions within 30 days of discharge, and continuance of hospital stay.

A sample of 18209 patients met the inclusion criteria for the research Of those, 75.6 percent did not receive antibiotic therapy before hospitalization. The remainder of the data is based upon the group that had received antibiotics before admission. The in-hospital mortality rate, mortality within 30 days of admission, and amplification of stay were significantly better in patients who received the first dose of antibiotics within four hours of admission to the hospital. The mean reduction in longitudinal dimensions of stay was 0.4 days in patients who received early antibiotics compared with those who received them after the four-hour period. The timing of the administration of antibiotics had no impact in succession readmissions within 30 days after discharge.

The authors gather that antibiotic administration within four hours of arrival at the hospital in patients with CAP had a positive impact forward mortality and length of stay. They add that early administration can cut down in-hospital mortality in the Medicare population and form costs, and should be feasible in greatest in quantity patients.

Houck PM et al. Timing of antibiotic administration and consequences for Medicare patients hospitalized with community- acquired pneumonia. Arch Intern M March 22 2004;164:637-44

COPYRIGHT 2005 American Academy of Family Physicians

COPYRIGHT 2005 Gale Group