For Patients With CAP, HAP, Antimicrobial Treatment Duration Often Exceeds Recommendations

HealthDay News — Antimicrobials are often prescribed for a longer duration than recommended in guidelines, according to a study published online in the Journal of Hospital Medicine.

Karl J. Madaras-Kelly, PharmD., MPH, from Idaho State University in Meridian, and colleagues conducted a retrospective medication utilization evaluation in 30 Veterans Affairs Medical centers. Electronic medical records were reviewed for inpatients discharged with uncomplicated community-acquired pneumonia (CAP) or health care-associated pneumonia (HCAP). Data were included for 1,739 patients: 1,195 with CAP and 544 with HCAP. Appropriate therapy duration was defined as at least five days for CAP and eight days for HCAP.

The researchers found that 13.9% of patients received therapy consistent with guideline recommendations (CAP, 6.9% and HCAP, 29.0%). The median days of therapy were four days for inpatient intravenous antimicrobials, one day for inpatient oral antimicrobials, and six days for outpatient oral antimicrobials. Clostridium difficile infection was rare but was seen more often in patients who received guideline-consistent therapy duration. There was no correlation noted for therapy duration with readmission or mortality rate.

“The majority of excessive therapy was completed upon discharge, identifying the need for strategies to curtail unnecessary use post-discharge,” the authors write.


1. Madaras-Kelly KJ, Burk M, Caplinger C, et al. Total duration of antimicrobial therapy in veterans hospitalized with uncomplicated pneumonia: Results of a national medication utilization evaluation. J Hosp Med. 2016; doi: 10.1002/jhm.2648.