Clinical Citations: Managing pneumonia: How good are the practice guidelines?

Just how effective are the national guidelines for the management of community-acquired pneumonia (CAP)? Pretty good, according to Mortensen and associates. They found that compliance with practice guidelines, such as those published by the Infectious Diseases Society of America and the American Thoracic Society, is associated with a reduced mortality in patients with CAP.

They retrospectively studied 420 patients with CAP, 323 of whom received antibiotic therapy that was concordant with national guidelines. Guideline-concordant antibiotics for patients on the medical wards included a ß-lactam with doxycycline or a macrolide, an antipneumococcal fluoroquinolone alone, or azithromycin alone for patients with no history of cardiopulmonary disease or other factors, such as nursing home residence (Table). For patients in the ICU, guideline-concordant antibiotics included a ß-lactam with a macrolide or an antipneumococcal fluoroquinolone; or antipneumococcal fluoroquinolone with clindamycin, vancomycin, or an aminoglycoside (for penicillin-allergic patients).

At 30 days after presentation, the mortality rate was 6.2% in those who received the recommended therapy. In contrast, the mortality rate was 21.7% in those who received antibiotics that were not concordant with guidelines. After adjustment for confounding variables, failure to comply with antibiotic guidelines was found to be associated with an increased mortality risk (odds ratio, 5.7).