Presented at the Society for Academic Emergency Medicine annual meeting, Boston, MA, June 2011.
Original Research Contribution
National Study of Antibiotic Use in Emergency Department Visits for Pneumonia, 1993 Through 2008
Article first published online: 17 MAY 2012
© 2012 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 19, Issue 5, pages 562–568, May 2012
How to Cite
Neuman, M. I., Ting, S. A., Meydani, A., Mansbach, J. M. and Camargo, C. A. (2012), National Study of Antibiotic Use in Emergency Department Visits for Pneumonia, 1993 Through 2008. Academic Emergency Medicine, 19: 562–568. doi: 10.1111/j.1553-2712.2012.01342.x
Dr. Camargo was funded, in part, by NIH grant R01 [grant AI-93723] (Bethesda, MD).
The authors have no potential conflicts of interest to disclose.
Supervising Editor: Christopher R. Carpenter, MD, MSc.
- Issue published online: 17 MAY 2012
- Article first published online: 17 MAY 2012
- Received September 8, 2011; revisions received October 27 and November 16, 2011; accepted November 16, 2011.
ACADEMIC EMERGENCY MEDICINE 2012; 19: 562–568 © 2012 by the Society for Academic Emergency Medicine
Objectives: The Infectious Disease Society of America (IDSA) and American Thoracic Society (ATS) developed guidelines for the management of community-acquired pneumonia (CAP); however, there are sparse data on actual rates of antibiotic use in the emergency department (ED) setting.
Methods: Data were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for ED visits during 1993 through 2008 for adults with a diagnosis of pneumonia.
Results: During the study period there were an estimated 23,252,000 pneumonia visits, representing 1.8% of all ED visits. The visit rate for pneumonia during this 16-year period may have increased (p trend = 0.055). Overall, 66% of adult patients with a primary diagnosis of pneumonia had documentation of an antibiotic administered while in the ED. There was an increase in antibiotic administration for adults with pneumonia from 1993 through 2008 (49% to 80%; p trend < 0.001). Specifically, there was an increase in use of macrolides from 1993 to 2006 (20% to 30%, p trend < 0.001) and a marked increase in use of quinolones from 0% to 39% from 1993 through 2008 (p trend < 0.001). Penicillin and cephalosporin use remained stable. Use of an antibiotic consistent with 2007 IDSA/ATS guidelines increased from 22% (95% confidence interval [CI] = 16% to 27%) of cases in 1993–1994 to 68% (95% CI = 63% to 73%) of cases in 2007–2008 (p trend < 0.001).
Conclusions: ED visit rates for pneumonia increased slightly from 1993 through 2008. Although antibiotic administration in the ED has increased for adults with CAP, guideline-concordant antibiotics may not be consistently administered.