OUTPATIENT TREATMENT OF COMMUNITY- ACQUIRED PNEUMONIA: EVOLVING TRENDS AND A FOCUS ON FLUOROQUINOLONES

Main Article Content

Anita G Carrie
Anita L Kozyrskyj

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.

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