Oral Azithromycin Prescribing Practices for Community-Acquired Pneumonia at the Emergency Department of a Tertiary Hospital: An Observational Study

Background: The emergency department (ED) plays a crucial role in addressing improper antibiotic prescribing, which is essential for reducing antimicrobial resistance (AMR) and preventing harm to patients. The increased use of oral azithromycin for treating community-acquired pneumonia (CAP) in the ED highlights the need for this study. Objectives: To describe the prescribing practices and assess the appropriateness of oral azithromycin prescribing for CAP treatment in the ED of a tertiary hospital. Methods: This retrospective observational study included patients aged 18 years and older who presented to the ED with CAP and were prescribed oral azithromycin. Results: A total of 165 patients were enrolled, with 53.3% being female and under 65 years old. The majority (83.6%) had at least one comorbidity, with hypertension being the most prevalent (63.6%). Two-thirds of patients had a CURB-65 score of less than 2. A 3-day course of oral azithromycin (500 mg once daily) was the most frequently prescribed regimen (67.9%), while intravenous (IV) amoxicillin/clavulanate was the most administered concurrent antibiotic (69.3%). Among the 118 hospitalised patients, a CURB-65 score of less than 2 was the main reason (21.6%) for discontinuing oral azithromycin. Approximately 74% of prescriptions complied with national guidelines, with non-adherence primarily due to inappropriate treatment choices for outpatients without comorbidities. Guideline adherence was significantly higher in patients aged 65 or older and those with comorbidities. Conclusion: Oral azithromycin prescribing adherence for CAP in the ED was moderate, with compliance rates in similar studies ranging from 7% to 95%, underscoring the need for strengthened antimicrobial stewardship programmes.