Background Acute community-acquired pneumonia (CAP) is a widespread infection worldwide, causing many hospitalisations and deaths. The repeated and inappropriate use of antibiotics is the main cause of the emergence of bacterial resistance that can lead to therapeutic dead ends.
Purpose This study assessed the pharmacological management of CAP in community and hospital settings, according to the applicable national standards (NS).
Material and methods This was a retrospective and observational study, performed over 1 year in 13 short-stay wards in a 2,000-bed health facility. The patients included had a CAP previously treated in the community, knowing that each patient could be treated with one or more antibiotic strategies. Two infectious physicians and a senior clinical pharmacist analysed the compliance of antibiotic orders to NS for the medication choice (M), the medication dosage (P) and the treatment duration (D).
Results A total of 204 patients were included. The rates of patients with at least one non-compliance were 67.9% and 45.9% respectively in the community (n=187 patients) and hospital (n=181). The antibiotic therapies were non-compliant to NS for 44.5% on M (n=238 antibiotic therapies), versus 33.2% (n=226) respectively in the community and hospital, 20.6% on P (n=218) versus 4.9% (n=226) and 30.6% on D (n=206) versus 19.0% (n=216). In the emergency department (n=47), 23.8% and 6.1% of antibiotic orders were non-compliant for M and P, respectively.
Other works published in the literature on the rate of intra-hospital nonconformities present results similar to ours. This innovative study (hitherto never performed in the outpatient sector in France) reminds us of the importance of respecting the recommendations for optimal recovery of patients with CAP, avoiding multiple re-hospitalisations and preserving the efficacy of the existing antibiotic arsenal.
Conclusion Non-compliance to NS for antibiotic therapies can be explained by the multiplicity of prescribers, a lack of communication, a difficult access to clinico-therapeutic recommendations, microbiological information and medical imagery tests.
There is an urgent need to strengthen continuous training and to set up better coordination of care between community and hospital health professionals.
References and/or acknowledgements http://ansm.sante.fr/var/ansm_site/storage/original/application/b33b6936699f3fefdd075316c40a0734.pdf
No conflict of interest.