Adherence to antibiotherapy guidelines for acute community-acquired pneumonia in adults, in a teaching hospital

Objective. - The authors had for aim to assess the conformity of antibiotic prescription with guidelines, for the management of community-acquired pneumonia, in a French University Hospital. Design. - This prospective study included adults patients hospitalized for pneumonia over a period of six months. The attending physician estimated the severity of pneumonia. The adequacy to guidelines focused on: first antibiotic choice and prescription modality, antibiotic choice in case of treatment modification at 48 to 72 hours, and duration of antibiotherapy. Results. - A hundred and nine cases of pneumonia were included in 106 patients. The mean age was 66 years, the mortality rate was 17%. Bacterial documentation was recorded in 40.4% of cases. The first antibiotics used were in accordance with guidelines in 52.3% of cases. The non conformity rate was minor in 55.8% of cases. Antibiotherapies putting the patient at risk were used in less than 10% of the cases. The rate of antibiotic modification at 48 to 72 hours was 46.8%, primarily for bacteriological purposes (35.3%) or initial treatment failure (27.4%). The treatment duration was inappropriate in 52.7% of cases and generally too long in case of non conformity. Conclusion. - It seems important to support guideline information, training of prescribers, and to consult an antibiotic expert. (C) 2010 Elsevier Masson SAS. All rights reserved.