The reasons for prescribing unnecessarily broad-spectrum antibiotics for pneumonia

Background Broad-spectrum antibiotic therapy may be harmful. This study investigated the factors leading to unnecessarily broad-spectrum empiric antibiotic therapy in community-acquired pneumonia (CAP), in relation to its severity.

Methods A retrospective analysis of patients visiting a tertiary hospital due to CAP in 2018. Appropriateness of the antibiotic therapy was defined according to the national pneumonia guideline. The severity of pneumonia was assessed utilizing the CRB-65 scoring.

Results 340 (72.3 %) out of the 470 CAP patients received adequate and 130 (27.7 %) unnecessarily broad-spectrum empiric antibiotic therapy, usually due to mild CAP. Unnecessarily broad-spectrum empiric antibiotic therapy was mainly associated with high blood C-reactive protein (CRP) count (adjusted odds ratio 1.60 per quartile (95 % confidence interval 1.29-1.99).

Conclusions Most of the CAP patients received adequate empiric antibiotic therapy. The use of CRP count to choose the spectrum of the antibiotic therapy should be questioned. Appropriateness of the antibiotic therapy might improve by better utilization of validated severity scoring to guide the therapy.

Heikki Koskela, Marko Mäntynen, Riitta-Liisa Patovirta