Pneumonia is something we are all familiar, either through word of mouth, the news, or first-hand experience. And while most of us know that it exists; most people don’t much else about it. Like that it is the number one killer of children under five in the world, or, this recent discovery; that nearly one in four patients treated with antibiotics for community-acquired pneumonia required additional antibiotic therapy, had to be hospitalized, or ended up in the emergency department, according to a study of more than 250,000 patients.
“We found it very surprising how frequently treatment fails,” said investigator James McKinnell, MD, from the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center in Torrance, California.
“Doctors need to be more aware of what they’re tackling; community-acquired pneumonia is not to be trifled with,” he told reporters.
Dr. McKinnell presented the results here at American Thoracic Society 2017 International Conference. Of the 251,947 cases identified, 55,741 patients (22.1%) needed further antibiotic treatment or ended up in the hospital. Furthermore, it was found that patients older than 65 were nearly three times more likely to be hospitalized than younger patients, and nearly two times more likely after adjustment for risk.
Older patients are more vulnerable and should be treated more carefully, “potentially with more aggressive antibiotic therapy,” Dr. McKinnell explained. “This really shows that the current standard of care doesn’t result in what we thought. We’ve got to get better at this.”
There were significant regional variations in patient resistance to certain antibiotics; people on the East Coast did better than those on the West Coast, Dr. McKinnell reported. “There might be less antibiotic resistance in that area.”
Wait, does that mean that depending on where you are geographical may impact your treatment?
“Region ends up being a really important factor, he explained. “Different antibiotics have resistance in different parts of the country, so that drives how your patients do.”
“More fluoroquinolones are prescribed in some parts of the country than others, so it follows that bacteria in those parts of the country will have different patterns of resistance.” In this study, the data indicate that a broader antibiotic is needed on the West Coast.
“If you’re not aware of outcomes in your area, you don’t know what’s driving outcomes,” he said. “If we’re going to use antibiotics, we’ve got to make sure we’re using the right ones.”
Physicians are usually not aware if the treatment they prescribed actually worked. “Often you don’t get your patients coming back; they end up in emergency rooms, so primary care doesn’t know that they did poorly,” Dr. McKinnell explained.
Hopefully, these findings will lead to sweeping changes when it comes to how medical professionals handle pneumonia and how the national database is maintained. “It doesn’t tell you how the patient presented, or what workup was done,” he pointed out. The patient might have had bronchitis or a subtle presentation of lung disease; “these are known to fail on antibiotics,” he said. “The biggest reason for treatment failure” is related to diagnostic criteria.