Annals for Hospitalist Inpatient Notes - Optimal Treatment Duration for Patients Hospitalized With Pneumonia—The Benefits of Less
Authors: Scott A. Flanders
Journal: Annals of Internal Medicine (2019)

Web Exclusives20 August 2019Annals for Hospitalists Inpatient Notes - Optimal Treatment Duration for Patients Hospitalized With Pneumonia—The Benefits of LessScott A. Flanders, MDScott A. Flanders, MDUniversity of Michigan, Ann Arbor, Michigan (S.A.F.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-2235 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Traditionally, community-acquired pneumonia (CAP) has been treated with a total of 7 to 14 days of antibiotic therapy. Contemporary guidelines recommend shorter courses, but overtreatment remains common. A recent evaluation of pneumonia treatment in 43 diverse hospitals in Michigan showed that two thirds of patients received antibiotics for longer than the shortest effective duration consistent with guidelines (1). Reasons for the widespread excess are unclear. However, an overwhelming body of evidence shows that shorter durations of antibiotic treatment lead to favorable clinical outcomes with fewer antibiotic-associated adverse effects and reduce the selective pressure that drives antibiotic resistance.Short- Versus Long-Course ...References1. Vaughn VM, Flanders SA, Snyder A, et al. Excess antibiotic treatment duration and adverse events in patients hospitalized with pneumonia. A multihospital cohort study. Ann Intern Med. 2019;171:153-63. [PMID: 31284301]. doi:10.7326/M18-3640 LinkGoogle Scholar2. Dimopoulos G, Matthaiou DK, Karageorgopoulos DE, et al. Short- versus long-course antibacterial therapy for community-acquired pneumonia: a meta-analysis. Drugs. 2008;68:1841-54. [PMID: 18729535] CrossrefMedlineGoogle Scholar3. Uranga A, España PP, Bilbao A, et al. Duration of antibiotic treatment in community-acquired pneumonia: A multicenter randomized clinical trial. JAMA Intern Med. 2016;176:1257-65. [PMID: 27455166] doi:10.1001/jamainternmed.2016.3633 CrossrefMedlineGoogle Scholar4. Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the infectious diseases society of america and the american thoracic society. Clin Infect Dis. 2016;63:e61-e111. [PMID: 27418577] doi:10.1093/cid/ciw353 CrossrefMedlineGoogle Scholar5. Huang DT, Yealy DM, Filbin MR, et al; ProACT Investigators. Procalcitonin-guided use of antibiotics for lower respiratory tract infection. N Engl J Med. 2018;379:236-49. [PMID: 29781385] doi:10.1056/NEJMoa1802670 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Michigan, Ann Arbor, Michigan (S.A.F.)Disclosures: Dr. Flanders reports personal fees for expert testimony, grants from Blue Cross Blue Shield of Michigan and the Agency for Healthcare Research and Quality, and personal fees from Wiley Publishing outside the submitted work. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-2235.Corresponding Author: Scott A. Flanders, MD, Professor of Medicine, Chief Clinical Strategy Officer, University of Michigan, 3110G Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists - 20 August 2019 David H. Wesorick and Vineet Chopra Metrics 20 August 2019Volume 171, Issue 4Page: HO2-HO3KeywordsAntibioticsBacterial diseasesEndocarditisMedical risk factorsMortalityPatientsPneumoniaRespiratory system proceduresTreatment guidelinesVentilator associated pneumonia ePublished: 20 August 2019 Issue Published: 20 August 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...