Longer Antibiotic Treatment for Pneumonia Isn’t Always Better

MedicalResearch.com Interview with:

Valerie M. Vaughn, MD MSc Assistant Professor of Medicine and Research Scientist, Division of Hospital Medicine The Patient Safety Enhancement Program and Center for Clinical Management Research Michigan Medicine and the Ann Arbor VA Medical Center

Dr. Vaughn

Valerie M. Vaughn, MD MSc
Assistant Professor of Medicine and Research Scientist, Division of Hospital Medicine
The Patient Safety Enhancement Program and Center for Clinical Management Research
Michigan Medicine and the Ann Arbor VA Medical Center 

MedicalResearch.com: What is the background for this study?

Response: Pneumonia is one of the top causes for hospitalization and one of the main reasons for antibiotic use in US hospitals. In the past decade, studies have suggested that patients can be safely treated with short course antibiotic therapy instead of the prolonged courses we used to prescribe.

Our study looked at prescribing practices in 43 hospitals across the state of Michigan to see if we were appropriately prescribing short course therapy, and if so, how that affected patients.

MedicalResearch.com: What are the main findings? 

Response: What we found was surprising. After looking at more than 6,000 patients hospitalized with pneumonia, we found two-thirds received longer antibiotic courses than necessary.

These long antibiotic courses were harmful: patients were more likely to have side effects for every extra day of antibiotics they received. We also found that 90% of extra days occurred after patients left the hospital, meaning both doctors and patients should stop and think about the length of antibiotic prescriptions as patients are discharged. 

MedicalResearch.com: What should readers take away from your report?

Response: Longer isn’t necessarily better. In fact, when it comes to antibiotics. Shorter is often better. I really hope that doctors and patients both will think of each extra day as potentially harmful and only prescribe treatment that is absolutely needed. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Now that we know so many patients are receiving long antibiotic courses, and that most of this “extra” treatment comes at discharge, we really need to know how to “fix” the prescribing problem. At the University of Michigan, we’re taking these findings and trying to create a process to improve antibiotic use at discharge by bringing together pharmacists and physicians to really think about antibiotics before patients leave the hospital. So far it seems to be really working, but we need to know whether this can reduce antibiotic side effects as well. 

MedicalResearch.com: Is there anything else you would like to add?

Response:
I’d like to really thank all of my collaborators. This project was made possible because hospitals across Michigan decided to come together and work together to improve care. This work couldn’t be done without them (http://mi-hms.org/quality-initiatives/antimicrobial-use-initiative) or our funders, Blue Cross and Blue Shield of Michigan and Blue Care Network.

I have no other disclosures 

Citation:

Excess Antibiotic Treatment Duration and Adverse Events in Patients Hospitalized With Pneumonia

Valerie M. Vaughn, MD, MSc; Scott A. Flanders, MD; Ashley Snyder, MS; Anna Conlon, PhD; Mary A.M. Rogers, PhD, MS; Anurag N. Malani, MD; Elizabeth McLaughlin, MS, RN; Sarah Bloemers, MPH; Arjun Srinivasan, MD; Jerod Nagel, PharmD, BCPS; Scott Kaatz, DO; Danielle Osterholzer, MD; Rama Thyagarajan, MD; Lama Hsaiky, PharmD, BCPS; Vineet Chopra, MD, MSc; Tejal N. Gandhi, MD

Published: Ann Intern Med. 2019.
DOI: 10.7326/M18-3640
©2019 American College of Physicians

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