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Colds and flu

05 August 2019

Do pneumonia patients get too many antibiotics?

A study found that the more days of antibiotics a pneumonia patient received beyond the recommended minimum, the higher their risk of experiencing side effects.

Two-thirds of hospitalised pneumonia patients may be prescribed antibiotics for too long, increasing their risk for potentially harmful side effects, researchers say.

In 93% of cases, over-prescription involved the number of antibiotics patients received upon being discharged from the hospital.

Higher risk of side effects

Each year in the United States, pneumonia sends one million adults to the hospital. The new study examined the medical records of 6 500 pneumonia patients treated at 43 Michigan hospitals. Of those, 60% were interviewed by phone within a month after they left the hospital.

Most patients who received too-long prescriptions for antibiotics got an average of two extra days' worth of pills, according to a research team led by Dr Valerie Vaughn of the University of Michigan. As she explained, the more days of antibiotics a patient received beyond the recommended minimum, the higher their risk of experiencing side effects such as upset stomach or yeast infections.

"'Antibiotic stewardship', which includes choosing the right drug and the right duration for each patient, has become a part of most hospitals," said Vaughn, an assistant professor of internal medicine.

"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," she said in a university news release.

National guidelines not precise

Over-prescription of antibiotics is also a known contributor to antibiotic resistance, where bacteria find ways to mutate around the drugs.

The study found wide variation among hospitals in the percentage of pneumonia patients who were prescribed antibiotics for too long. In some hospitals less than 50% of patients got too many of the drugs, while other hospitals gave an oversupply to nearly every patient.

Adding to the problem is the fact that national guidelines for treating pneumonia are not precise, Vaughn noted.

She said that determining the amount of antibiotics a pneumonia patient requires depends on their diagnosis, plus how long it took them to stabilise after treatment began. In general, most patients without risk factors need about five days' worth of antibiotics; while those with risk factors, or pneumonia caused by especially difficult bacteria, need about seven days' worth, Vaughn said.

The study was published in the journal Annals of Internal Medicine.

Image credit: iStock

 

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Flu expert

Dr Heidi van Deventer completed her MBChB (Bachelor of Medicine and Bachelor of Surgery) degree in 2004 at the University of Stellenbosch.
She has additional training in ACLS (Advanced Cardiac Life Support) and PALS (Paediatric Advanced Life Support) as well as biostatistics and epidemiology.

Dr Van Deventer is currently working as a researcher at the Desmond Tutu Tuberculosis Centre at the University of Stellenbosch.

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