OUTPATIENT TREATMENT OF COMMUNITY- ACQUIRED PNEUMONIA: EVOLVING TRENDS AND A FOCUS ON FLUOROQUINOLONES
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Keywords
community-acquired pneumonia, outpatients, drug utilization, antibiotics, fluoroquinolones
Abstract
Background
Increasing use of broad-spectrum antibiotics in the community, including fluoroquinolones, has been reported, despite concerns for developing antibiotic resistant organisms. Community-acquired pneumonia (CAP) is commonly treated on an outpatient basis, and recent treatment guidelines suggest only a limited role for fluoroquinolones.
Objectives
To identify evolving trends in the outpatient treatment of CAP in adults, and to identify factors associated with receipt of a fluoroquinolone.
Methods
Retrospective observational design using population-based administrative data. Initial outpatient treatment for subjects diagnosed with CAP between May 1996 and March 2002 was examined. Logistic regression was used to examine the influence of patient characteristics on the receipt of a fluoroquinolone.
Results
A total of 31,940 outpatients with CAP were identified. The proportion of patients receiving fluoroquinolones increased from 6.6% in 1996/97 to 25.2% in 2001/02. Over the course of the study, 158 (25.9%) of the 610 patients meeting the eligibility criteria for treatment with fluoroquinolones, according to treatment guidelines, received these agents. Of the 31,330 subjects who did not meet the eligibility criterion, 3,886 (12.4%) received a fluoroquinolone. Other variables that influenced the receipt of a fluoroquinolone included: age (for every 10-year increase) [OR=1.16 (1.14-1.19)], urban residence [OR=1.40 (1.30-1.51)], presentation to an emergency department [OR=0.80 (0.70-0.90)], high-level drug use (six or more different drugs in the previous year) [OR=1.50 (1.41-1.59)], and income-level (highest to lowest) [OR=1.20 (1.08-1.35)].
Conclusion
The use of fluoroquinolones for the treatment of CAP is increasing. However less than 4% of the subjects receiving fluoroquinolones met eligibility requirements according to treatment guidelines. Initiatives to increase the uptake of treatment guidelines appear warranted.
References
2. Carrie AG, Metge CJ, Zhanel GG. Antibiotic use in a Canadian Province, 1995-1998. Ann Pharmacother 2000;34:459-64.
3. Kozyrskyj AL, Carrie AG, Mazowita GB, Lix LM, Klassen TP, Law BJ. Decrease in antibiotic use in children in the 1990's: not all antibiotics, not all children. Can Med Assoc J 2004.
4. McManus P, Hammond ML, Whicker SD, Primrose JG, Mant A, Fairall SR. Antibiotic use in the Australian community, 1990-1995. Med J Aust 1997;167:124-127.
5. Henricson K, Melander E, Molstad S et al. Intra-urban variation of antibiotic utilization in children: influence of socio-economic factors. Eur J Clin Pharmacol 1998;54:653-657.
6 McCombs JS, Nichol MB. The use of first and second-line outpatient antibiotics under the Saskatchewan Drug Plan. Pharmacoeconomics 1995;7:543-554.
7 Straand J, Rokstad K, Sandvik H. Prescribing systemic antibiotics in general practice. A report from the More and Romsdal Prescription Study. Scand J Prim Health Care 1997;16:121-127.
8. LeLorier J, Derderian F. Effect of listing ciprofloxacin in provincial formularies on hospitalizations for bronchitis and pyelonephritis. Can J Clin Pharmacol
1998;5:133-137.
9. Mandell LA, Marrie TJ, Grossman RF, Chow AW, Hyland RH. Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society. Clin Infect Dis 2000;31:383-421.
10. Mandell LA, Niederman M. Antimicrobial treatment of community acquired pneumonia in adults: A conference report. Can J Infect Dis 1993;4:25-28.
11. Manitoba Health. Manitoba drug benefits and interchangeability ormulary. http://www.gov.mb.ca/health/mdbif/pdca48.p df (November 13, 2005).
12. Reid R, MacWilliams L, Roos NP, Bogdanovic B, Black C. Measuring morbidity in populations: performance of the John Hopkins Adjusted Clinical Group (ACG) Case-Mix System in Manitoba. Winnipeg: Manitoba Centre for Health Policy; 1999.
13. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9- CM administrative databases. J Clin Epidemiol 1992;45:613-9.
14. Birkett DJ, Mitchell AS, Godeck A, Grigson T, Cully R, Lee C. Profiles of antibacterial drug use in Australia and trends from 1987 to 1989. Med J Aust 1991;155:410-415.
15. Steinman MA, Gonzales R, Linder JA, Landefeld S. Changing use of antibiotics in community-based outpatient practice, 1991-1999. Ann Intern Med 2003;138:525-533.
16. Malcolm C, Marrie TJ. Antibiotic therapy for ambulatory patients with community-acquired pneumonia in an emergency department setting. Arch Intern Med 2003;163:797-802.
17. Pennie RA. Prospective study of antibiotic prescribing for children. Can Fam Physician 1998;44:1850-1856.
18. Raisch DW. A model of methods for influencing prescribing: Part II. A review of educational methods, theories of human inference, and delineation of the model. Ann Pharmacother 1990;24:537-542.
19. Bateman DN, Campbell M, Donaldson LJ, Roberts SJ, Smith JM. A prescribing incentive scheme for non-fundholding general practices: an observational study. Br Med J 1996;313:535-538.
20. Himmelberg CJ, Pleasants RA, Weber DJ et al. Use of antimicrobial drugs in adults before and after removal of a restriction policy. Am J Hosp Pharm 1991;48:1220-1227.
21. Sketris IS, Metge C, Shevchuk Y et al. Comparison of anti-infective drug use in elderly persons in Manitoba, Nova Scotia, and Saskatchewan, Canada: relationship to drug insurance reimbursement policies. Am J Geriatric Pharmacotherapy 2004;2:24-35.
22. Cates C. An evidenced based approach to reducing antibiotic use in children with acute otitis media: controlled before and after study. Br Med J 1999;318:715-6.
23. Ilett KF, Johnson S, Greenhill G et al. Modification of general practitioner prescribing of antibiotics by use of a therapeutics adviser (academic detailer). Br J Clin Pharmacol 2000;49:168-173.
24. Stewart J, Pilla J, Dunn L. Pilot study for appropriate anti-infective community therapy. Effect of a guideline-based strategy to optimize use of antibiotics. Can Fam Physician 2000;46:851-9.
25. Majumdar SR, Soumerai SB. Why most interventions to improve physician prescribing do not seem to work. CMAJ 2003;169:30-1.
26. Humphries KH, Rankin JM, Carere RG, Buller CE, Kiely FM, Spinelli JJ. Co- morbidity data in outcomes research: are clinical data derived from administrative databases a reliable alternative to chart review? J Clin Epidemiol 2000;53:343-9.
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