One drug or two? Step‐down therapy after i.v. antibiotics for community‐acquired pneumonia

Background: The aim of the study was to describe the oral antibiotics prescribed as step‐down therapy for patients hospitalized for community‐acquired pneumonia (CAP). Methods: A comparative audit of patient records in a Sydney teaching hospital, a district referral hospital and a regional hospital was carried out. Patients older than 15 years admitted between 1 July 2004 and 31 December 2004 with a diagnosis of CAP were identified by diagnostic code. The medical records were reviewed for patient demographics, the specialty of the attending physician, comorbidities, adverse drug events, relevant microbiological results and the antibiotic therapy prescribed for the treatment of pneumonia. Cases were randomly selected from all pneumonia admissions, with approximately equal numbers from urban and regional hospitals. One hundred and ninety‐six admissions for CAP (in 193 patients) were included in this review. Patients were predominantly cared for by respiratory physicians (62%) and geriatricians (14%). Eighty‐nine per cent of patients received dual antibiotic therapy on admission. Results: For patients commenced on two antibiotics, 62% were prescribed two oral antibiotics after completing i.v. therapy, 27% were prescribed one oral agent and 11% were prescribed no step‐down therapy. Geographic location and the presence of a documented antibiotic allergy affected prescribing practice. Neither the specialty of the attending medical officer nor the identification of a likely pathogen affected prescribing practice. Conclusion: Although most of the patients with CAP were initially prescribed two antibiotics, there was considerable variability in whether one, two or no oral agents were prescribed as step‐down therapy.     

PDCA循环管理用于抗菌药物专项点评效果评价

目的 促进临床合理使用抗菌药物.方法 运用PDCA循环管理法分析医院临床使用抗菌药物存在的问题,寻找原因,制订对策并实施干预,比较管理前(即计划阶段,P)与管理中(即执行阶段,D)抗菌药物的使用量、金额及抗菌药物处方合理率.结果 与计划阶段相比,执行阶段抗菌药物的使用率降低,抗菌药物的使用逐渐合理,抗菌药物滥用情况得到...