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National Study of Antibiotic Use in Emergency Department Visits for Pneumonia, 1993 Through 2008
Academic Emergency Medicine, 05/21/2012
Neuman MI et al. - Emergency department (ED) visit rates for pneumonia increased slightly from 1993 through 2008. Although antibiotic administration in the ED has increased for adults with community-acquired pneumonia (CAP), guideline-concordant antibiotics may not be consistently administered.
Methods- Data were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for ED visits during 1993 through 2008 for adults with a diagnosis of pneumonia.
- During the study period there were an estimated 23,252,000 pneumonia visits, representing 1.8% of all ED visits.
- The visit rate for pneumonia during this 16-year period may have increased (p trend = 0.055).
- Overall, 66% of adult patients with a primary diagnosis of pneumonia had documentation of an antibiotic administered while in the ED.
- There was an increase in antibiotic administration for adults with pneumonia from 1993 through 2008 (49% to 80%; p trend<0.001).
- Specifically, there was an increase in use of macrolides from 1993 to 2006 (20% to 30%, p trend<0.001) and a marked increase in use of quinolones from 0% to 39% from 1993 through 2008 (p trend<0.001).
- Penicillin and cephalosporin use remained stable.
- Use of an antibiotic consistent with 2007 IDSA/ATS guidelines increased from 22% (95% confidence interval [CI]=16% to 27%) of cases in 1993–1994 to 68% (95% CI=63% to 73%) of cases in 2007–2008 (p trend<0.001).
