Ann Arbor, MI—Patients leaving the hospital after treatment for pneumonia commonly receive prescriptions for too many days of antibiotics, according to a new study.

That was the case with two-thirds of the patients followed in a new study in Annals of Internal Medicine.

University of Michigan researchers reviewed medical records of nearly 6,500 pneumonia patients treated at 43 Michigan hospitals—and conducted phone conversations with 60% of them within a month of their hospital stay—to determine that 93% of the overly long antibiotic prescriptions given to pneumonia patients were written at hospital discharge.

The study points out that past randomized trials demonstrate no benefit from antibiotic treatment exceeding the shortest effective duration, leading the authors to examine predictors and outcomes associated with excess duration of antibiotic treatment. The retrospective cohort study focused on 6,481 general-care medical patients with pneumonia.

Defined as the primary outcome was the rate of excess antibiotic treatment duration, measured as days per 30-day period.

Results indicated that 67.8% of patients received excess antibiotic therapy. Those more likely to receive excess treatment were patients who
• Had respiratory cultures or nonculture diagnostic testing
• Had a longer stay
• Received a high-risk antibiotic in the prior 90 days
• Had community-acquired pneumonia or
• Did not have a total antibiotic treatment duration documented at discharge.

Researchers emphasize that excess treatment was not associated with lower rates of any adverse outcomes, including death, readmission, emergency department visit, or Clostridioides difficile infection. On the other hand, each excess day of treatment was associated with a 5% increase in the odds of antibiotic-associated adverse events reported by patients after discharge.

“Patients hospitalized with pneumonia often receive excess antibiotic therapy,” study authors conclude. “Excess antibiotic treatment was associated with patient-reported adverse events. Future interventions should focus on whether reducing excess treatment and improving documentation at discharge improves outcomes.”

“Antibiotic stewardship, which includes choosing the right drug and the right duration for each patient, has become a part of most hospitals,” added lead author Valerie Vaughn, MD, MSc, an assistant professor of internal medicine at U-M. “But these results show us that we need to pay more attention to stewardship at discharge—and suggest that guidelines for prescribers should be clearer about how to calculate an appropriate duration based on a patient’s condition.”

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