Antibiotics within 4 hours of arrival at hospital better for pneumonia patients

Giving older patients antibiotics within four hours of their arrival at a hospital for treatment of pneumonia reduces the length of hospital stay, and may reduce the chances of dying, according to an article in the March 22 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, pneumonia is the second leading reason for hospitalization among Medicare beneficiaries, accounting for more than 600,000 Medicare hospitalizations yearly, and is the fifth leading cause of death among Americans older than 65 years. Timely administration of antibiotics to hospitalized patients with pneumonia has been associated with improved survival, the article states. Guidelines recommend antibiotic treatment within eight hours of arrival at a hospital.

Peter M. Houck, M.D., from the Centers for Medicare & Medicaid Services, Seattle, and colleagues investigated whether administration of antibiotics within less than eight hours of arrival at the hospital was associated with significant improvements in hospitalized patients with pneumonia who had not been treated prior to arriving at the hospital.

The researchers examined medical records from a national random sample of 18,209 Medicare patients older than 65 years who were hospitalized with pneumonia from July 1998 through March 1999.

Among the 13,771 (75.6 percent) of patients who did not receive any treatment prior to their arrival at a hospital, antibiotic administration within four hours of arrival was associated with reduced death in the hospital (6.8 percent vs. 7.4 percent), reduced likelihood of dying within 30 days of admission to the hospital (11.6 percent vs. 12.7 percent) and reduced likelihood that the length of stay (LOS) at the hospital exceeded 5 days (42.1 percent vs. 45.1 percent). The average length of stay was an average of about half a day shorter for patients who received antibiotics within four hours of arriving at the hospital. The researchers also found that 60.9 percent of all patients received antibiotics within four hours of arriving at a hospital.

“The results of this study suggest that initial administration of antibiotics within four hours of arrival at the hospital is associated with reduced mortality among those patients who have not received antibiotics as outpatients and reduced hospital LOS among all patients,” write the authors. “While most Medicare inpatients with pneumonia already receive antibiotics within that time, a substantial proportion do not. Given the growing size of the Medicare population, any additional improvement in administration timing could prevent a substantial number of deaths each year and preserve health care resources.”

To contact Peter M. Houck, M.D., call the Centers for Medicare & Medicaid Services Office of Public Affairs at 202-690-6145.

(Arch Intern Med. 2004;164:637-644. Available post-embargo at archinternmed.com)

For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or e-mail mediarelations@jama-archives.org .

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