Utilization of broad‐ versus narrow‐spectrum antibiotics for the treatment of outpatient community‐acquired pneumonia among adults in the United States

Author:

Nickel Katelin B.1ORCID,Durkin Michael J.1ORCID,Olsen Margaret A.1ORCID,Sahrmann John M.1,Neuner Elizabeth2,O'Neil Caroline A.1,Butler Anne M.13ORCID,

Affiliation:

1. Department of Medicine, Division of Infectious Diseases Washington University School of Medicine St. Louis Missouri USA

2. Department of Pharmacy Barnes‐Jewish Hospital St. Louis Missouri USA

3. Department of Surgery, Division of Public Health Sciences Washington University School of Medicine St. Louis Missouri USA

Abstract

AbstractPurposeTo characterize antibiotic utilization for outpatient community‐acquired pneumonia (CAP) in the United States.MethodsWe conducted a cohort study among adults 18–64 years diagnosed with outpatient CAP and a same‐day guideline‐recommended oral antibiotic fill in the MarketScan® Commercial Database (2008–2019). We excluded patients coded for chronic lung disease or immunosuppressive disease; recent hospitalization or frequent healthcare exposure (e.g., home wound care, patients with cancer); recent antibiotics; or recent infection. We characterized utilization of broad‐spectrum antibiotics (respiratory fluoroquinolone, β‐lactam + macrolide, β‐lactam + doxycycline) versus narrow‐spectrum antibiotics (macrolide, doxycycline) overall and by patient‐ and provider‐level characteristics. Per 2007 IDSA/ATS guidelines, we stratified analyses by otherwise healthy patients and patients with comorbidities (coded for diabetes; chronic heart, liver, or renal disease; etc.).ResultsAmong 263 914 otherwise healthy CAP patients, 35% received broad‐spectrum antibiotics (not recommended); among 37 161 CAP patients with comorbidities, 44% received broad‐spectrum antibiotics (recommended). Ten‐day antibiotic treatment durations were the most common for all antibiotic classes except macrolides. From 2008 to 2019, broad‐spectrum antibiotic use substantially decreased from 45% to 19% in otherwise healthy patients (average annual percentage change [AAPC], −7.5% [95% CI −9.2%, −5.9%]), and from 55% to 29% in patients with comorbidities (AAPC, −5.8% [95% CI −8.8%, −2.6%]). In subgroup analyses, broad‐spectrum antibiotic use varied by age, geographic region, provider specialty, and provider location.ConclusionsReal‐world use of broad‐spectrum antibiotics for outpatient CAP declined over time but remained common, irrespective of comorbidity status. Prolonged duration of therapy was common. Antimicrobial stewardship is needed to aid selection according to comorbidity status and to promote shorter courses.

Funder

Centers for Disease Control and Prevention

Agency for Healthcare Research and Quality

Publisher

Wiley

Reference40 articles.

1. National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS).Annual number and percent distribution of ambulatory care visits by setting type according to diagnosis group: United States; 2009–2010. Accessed June 6 2018.https://www.cdc.gov/nchs/data/ahcd/combined_tables/2009-2010_combined_web_table01.pdf

2. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults

3. FileTM BondS.Treatment of community‐acquired pneumonia in adults in the outpatient setting.2023.https://www.uptodate.com/contents/treatment‐of‐community‐acquired‐pneumonia‐in‐adults‐in‐the‐outpatient‐setting?search=cap&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H2787226612

4. Effects of Antibiotics upon the Gut Microbiome: A Review of the Literature

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