Adherence to Antibiotic Guidelines in Acute Patients With Suspected Severe Pneumonia: A Cohort Study

Introduction: Community-acquired pneumonia (CAP) accounts for a substantial part of antibiotic prescriptions in emergency departments (EDs). Guidelines for empiric antibiotic treatment support rational use of antibiotics and should sharpen the indication and prevent overuse of antibiotics. Aim: This study aimed to investigate whether ED patients who were prescribed antibiotics for suspected severe pneumonia fulfilled the criteria for the treatment. Methods: This was a retrospective cohort study. The population consisted of adults hospitalized in two Danish EDs in the Central Denmark Region between July 1, 2022, and June 30, 2023, who were prescribed antibiotic treatment using the Standard Prescription Package: “Start package of severe pneumonia” (SPP-SP), containing piperacillin/tazobactam (Pip/Taz) plus clarithromycin. Review of electronic medical records (EMRs) was performed to decide whether the patients met the criteria for the SPP-SP. Results: 270 patients were included. In total, 103/270 (38%) patients fulfilled the criteria for treatment with the SPP-SP, whereas 167/270 (62%) patients did not. Conclusion: The criteria for prescribing antibiotics based on the severe pneumonia prescription package were fulfilled in only 38% of patients, reflecting a deviation in guideline adherence. This study provides useful and practical knowledge for implementation of new guidelines and focus areas in line with Antibiotic Stewardship.