Antibiotic use for Treatment of Pneumonia in Department of Internal Medicine

Abstract

Background Pneumonia is a common diagnosis in every hospital department. Misuse of antibiotics, too much broad-spectrum agents and too long duration of therapy, in the treatment of pneumonia has impact on the evolving trend of antibiotic resistance. Reports from a national quality register for pneumonia (NQRP11) of 5334 patients, 2011 show that there are shortcomings in the use of antibiotics for pneumonia treated in different infectious disease departments. Swedish Society of Infectious Diseases has put forward quality measures in the in-hospital treatment of community-acquired pneumonia. There is a lack of information about the quality of care for pneumonia in departments of internal medicine. The purpose of the present study is to compare the antibiotic use for treatment of pneumonia in internal medicine wards and infectious disease wards. Methods and results Review of the medical records of 80 patients who were treated for community- acquired pneumonia during 2011 in internal medicine wards in Skaraborg hospital, Skövde. Different quality parameters were studied during case review. For example: initial antibiotic treatment, antibiotic therapy after day 3, treatment duration, diagnostic use of respiratory tract culture. Cases were chosen randomly with equal gender presentation accordingly 40 male and 40 female patients. The results were compared with NQRP11. The patients in the study were older and suffered from more comorbid illnesses but the percentage with severe pneumonia were equal to the national cohort in infectious disease wards. Broad-spectrum antibiotics were used more often both empirically and as follow-up therapy. More patients received inappropriate long duration of therapy and a higher proportion was not subject to respiratory tract culture. Conclusions Patients with pneumonia cared for in various departments are not treated in the same way. This could be due to differences in age, concomitant diseases and disease severity. Patients in medical wards had higher median age and more comorbid illnesses but disease severity was equal. Overall antibiotic use for therapy of pneumonia had lower quality in medical wards than infectious disease wards. More studies are needed to elucidate the reasons for this. Educational efforts and increased awareness are needed in order to increase penicillin use, to reduce duration of antibiotic treatment, and to increase diagnostic procedures.