pneumonia

INTRODUCTION

Statistics Canada has reported pneumonia as the seventh leading cause of death in Canada, with the number of deaths due to pneumonia peaking in January. These statistics provide compelling reasons to ensure that patients with community-acquired pneumonia are treated effectively, to minimize the mortality rate. In addition to decreasing morbid­ity and mortality, effective treatment is important in minimiz­ing the financial burden on the health care system that is associated with admission to hospital for community-acquired pneumonia.

Previous studies have shown that strict adherence to clini­cal practice guidelines (e.g., the 2007 consensus guidelines of the Infectious Diseases Society of America [IDSA] and the American Thoracic Society [ATS]) decreases mortality and can reduce the length of the hospital stay for patients with community-acquired pneumonia. Specifically, Frei and oth­ers reported a reduction in average length of stay of 1.2 days (p < 0.01) and an absolute decrease in mortality of 4% (p < 0.01) with guideline-concordant empiric therapy relative to therapy not concordant with guidelines. In another study, utilization of a guideline-based physician order set decreased the odds ratio for death from 0.92 to 0.86. levitra 20 mg

The preprinted order for community-acquired pneumonia at the University Hospital of Northern British Columbia (UHNBC), which is available in print form on all wards and in the emergency department, includes levofloxacin as a treatment option for patients who have at least 1 of 3 specific indications: documented allergy to penicillin, failure of prior fi-lactam ther­apy, or known minimum inhibitory concentration of penicillin for Streptococcus pneumoniae of 4 mg/L or greater. In the year preceding the study reported here, pharmacists and physicians suspected an increase in inappropriate prescribing of levofloxacin (as defined by the specific criteria on the preprint­ed order, as outlined above) and observed a decrease in the susceptibility of S. pneumonia to levofloxacin, from 95% (for June 2007 to May 2008) to 81% (for June 2008 to May 2009). Additionally, reports of lack of attention to the indications for treatment with the levofloxacin regimen on the preprinted order raised questions as to whether other sections (specifically, University Hospital of Northern British Columbia. Cependant, lorsqu’elle etait utilisee, elle a accru l’observance du traitement empirique aux lignes directrices et favorise l’evaluation de l’etat vaccinal antipneumococcique des patients et l’utilisation de l’indice de gravite de la pneumonie.

Mots cles : pneumonie, lignes directrices, levofloxacine, vaccination, indice de gravite de la pneumonie, sensibilite microbienne [Traduction par l’editeur] those related to the pneumonia severity index and assessment of pneumococcal vaccination status) were being used appropriately. These concerns warranted assessment of prescribing habits at this institution.
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The primary objective of this study was to evaluate the treatment of patients with community-acquired pneumonia who were admitted to UHNBC to determine adherence to the preprinted order for treatment of this condition. The secondary objectives were to assess the appropriateness of prescribing of levofloxacin therapy in relation to the institution’s recommen­dations; to determine adherence with recommended treatment of community-acquired pneumonia as outlined in the recent IDSA—ATS guidelines; and to determine all-cause mortality, duration of IV antibiotic therapy, and length of stay for the various regimens reviewed.

The hypothesis was that the preprinted order for community- acquired pneumonia at UHNBC was not being utilized to its fullest extent and that levofloxacin was being prescribed more frequently than would be the case if the specific criteria of the preprinted order were being followed.