Duration of Antibiotic Use among Adults with Uncomplicated Community-Acquired Pneumonia Requiring Hospitalization in the United States

Abstract

Background

Previous studies suggest duration of antibiotic therapy for community-acquired pneumonia (CAP) often exceeds national recommendations and might represent an important opportunity to improve antibiotic stewardship nationally. The objective of this study was to determine average length of antibiotic therapy (LOT) for patients treated for uncomplicated CAP in US hospitals and proportion of patients with excessive durations.

Methods

Records of retrospective cohorts of patients 18-64 years with private insurance and ≥65 years with Medicare hospitalized for CAP in 2012-13 were utilized. Inpatient LOT was estimated as a function of LOS using MarketScan® Hospital Drug Database data. Outpatient LOT was based on prescriptions filled at discharge. Data were obtained from MarketScan® Commercial Claims and Encounters and 100% Medicare claims and Part D event files. Excessive duration was defined as outpatient LOT >3 days.

Results

Inclusion criteria were met for 22,128 patients 18-64 years across 2,100 hospitals and 130,746 patients ≥65 years across 3,227 hospitals. Median total LOT was 9.5 days. LOT exceeded recommended duration for 74% of patients 18-64 years and 71% of patients ≥65 years. Patients 18-64 years received a median (quartile 1 -quartile 3) 6 (3-7) days outpatient LOT and those ≥65 years 5 (3-7) days.

Conclusions

In this nationwide sample of patients hospitalized for uncomplicated CAP, median total LOT was just under 10 days, with over 70% of patients having likely excessive treatment duration. Better adherence to recommended duration of therapy for CAP by improving prescribing at hospital discharge may be an important target for antibiotic stewardship programs.