Broad-spectrum antibiotics are overused as a first-line defense in pneumonia care, a new study finds.
In fact, older pneumonia patients treated with these drugs fare no better than patients who receive standard care in the first days of hospitalization, reported lead author Barbara Jones, M.D., and colleagues from the University of Utah Health. Such patients also faced a 40% higher risk of dying within 30 days after discharge.
The problem may be a case of caution gone awry, Jones and colleagues suggested.
The study team tracked antibiotic use among more than 88,000 hospitalized veterans with pneumonia, ages 62 to 81. Compared with standard care using antibiotics such as ceftriaxone and azithromycin, the use of broad-spectrum drugs to target methicillin-resistant Staphylococcus aureus rose from 20% to nearly 50% of cases in a recent five-year period. Yet MRSA accounts for only 2% of pneumonia cases, the researchers said.
It’s difficult to pinpoint the pathogens responsible for individual pneumonia cases, the investigators acknowledged. But clinicians who target antibiotic-resistant bacteria as a first-line defense in older pneumonia patients may want to reconsider their strategy, said senior author Matthew Samore, M.D.
“Sometimes in our eagerness to improve outcomes, particularly among critically ill patients, we, as doctors, may be overly broad in our initial treatments,” Samore concluded.
The study was published in JAMA Internal Medicine.
