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Safety and efficacy of CURB65-guided antibiotic therapy in community-acquired pneumonia.
J Antimicrob Chemother. 2011 Feb; 66(2):416-23.JA

Abstract

OBJECTIVES

To determine whether the introduction of a community-acquired pneumonia (CAP) severity assessment tool to guide antibiotic selection could reduce broad-spectrum antibiotic prescribing without compromising patient safety.

METHODS

A prospective before and after evaluation study. Empirical antibiotic prescribing was studied for 18 months from June 2006 to January 2008 (pre-intervention) and then for 18 months following the implementation of a CURB65-guided antibiotic therapy guideline in June 2008. The primary outcome was the use of broad-spectrum antibiotics (cephalosporin, amoxicillin plus clavulanic acid and macrolides) in patients with CAP. Safety outcomes were 30 day mortality, requirement for mechanical ventilation and/or vasopressor support (MV/VS), development of complicated pneumonia, time to clinical stability (TCS) and length of hospital stay.

RESULTS

The introduction of CURB65-guided therapy resulted in an overall reduction in the prescription of cephalosporins (from 27.1% of patients receiving this agent in the overall pre-intervention cohort to 8.0% in the post-intervention cohort, P < 0.0001) and macrolides (72.8% to 58.7%, P < 0.0001), particularly among low-risk patients. There was a corresponding increase in the prescription of the narrower-spectrum agent amoxicillin (29.7% to 41.7%, P < 0.0001) and an increase in the use of amoxicillin monotherapy (10.4% to 29.9%, P < 0.0001). Co-amoxiclav use increased slightly as this agent replaced cephalosporins as first-line treatment for severe CAP. The guideline had no impact on 30 day mortality, MV/VS, complicated pneumonia, TCS or length of stay. Following the intervention, adherence to national guidelines increased from 25.4% of prescriptions to 61.9%, suggesting the potential for further improvements.

CONCLUSIONS

CURB65-guided antibiotic therapy was associated with a significant decrease in broad-spectrum antibiotic use. The intervention was safe with no impact on mortality, treatment failure or clinical response.

Authors+Show Affiliations

MRC Centre For Inflammation Research, Queens Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21081545

Citation

Chalmers, James D., et al. "Safety and Efficacy of CURB65-guided Antibiotic Therapy in Community-acquired Pneumonia." The Journal of Antimicrobial Chemotherapy, vol. 66, no. 2, 2011, pp. 416-23.
Chalmers JD, Singanayagam A, Akram AR, et al. Safety and efficacy of CURB65-guided antibiotic therapy in community-acquired pneumonia. J Antimicrob Chemother. 2011;66(2):416-23.
Chalmers, J. D., Singanayagam, A., Akram, A. R., Choudhury, G., Mandal, P., & Hill, A. T. (2011). Safety and efficacy of CURB65-guided antibiotic therapy in community-acquired pneumonia. The Journal of Antimicrobial Chemotherapy, 66(2), 416-23. https://doi.org/10.1093/jac/dkq426
Chalmers JD, et al. Safety and Efficacy of CURB65-guided Antibiotic Therapy in Community-acquired Pneumonia. J Antimicrob Chemother. 2011;66(2):416-23. PubMed PMID: 21081545.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safety and efficacy of CURB65-guided antibiotic therapy in community-acquired pneumonia. AU - Chalmers,James D, AU - Singanayagam,Aran, AU - Akram,Ahsan R, AU - Choudhury,Gourab, AU - Mandal,Pallavi, AU - Hill,Adam T, Y1 - 2010/11/16/ PY - 2010/11/18/entrez PY - 2010/11/18/pubmed PY - 2011/10/5/medline SP - 416 EP - 23 JF - The Journal of antimicrobial chemotherapy JO - J Antimicrob Chemother VL - 66 IS - 2 N2 - OBJECTIVES: To determine whether the introduction of a community-acquired pneumonia (CAP) severity assessment tool to guide antibiotic selection could reduce broad-spectrum antibiotic prescribing without compromising patient safety. METHODS: A prospective before and after evaluation study. Empirical antibiotic prescribing was studied for 18 months from June 2006 to January 2008 (pre-intervention) and then for 18 months following the implementation of a CURB65-guided antibiotic therapy guideline in June 2008. The primary outcome was the use of broad-spectrum antibiotics (cephalosporin, amoxicillin plus clavulanic acid and macrolides) in patients with CAP. Safety outcomes were 30 day mortality, requirement for mechanical ventilation and/or vasopressor support (MV/VS), development of complicated pneumonia, time to clinical stability (TCS) and length of hospital stay. RESULTS: The introduction of CURB65-guided therapy resulted in an overall reduction in the prescription of cephalosporins (from 27.1% of patients receiving this agent in the overall pre-intervention cohort to 8.0% in the post-intervention cohort, P < 0.0001) and macrolides (72.8% to 58.7%, P < 0.0001), particularly among low-risk patients. There was a corresponding increase in the prescription of the narrower-spectrum agent amoxicillin (29.7% to 41.7%, P < 0.0001) and an increase in the use of amoxicillin monotherapy (10.4% to 29.9%, P < 0.0001). Co-amoxiclav use increased slightly as this agent replaced cephalosporins as first-line treatment for severe CAP. The guideline had no impact on 30 day mortality, MV/VS, complicated pneumonia, TCS or length of stay. Following the intervention, adherence to national guidelines increased from 25.4% of prescriptions to 61.9%, suggesting the potential for further improvements. CONCLUSIONS: CURB65-guided antibiotic therapy was associated with a significant decrease in broad-spectrum antibiotic use. The intervention was safe with no impact on mortality, treatment failure or clinical response. SN - 1460-2091 UR - https://www.unboundmedicine.com/medline/citation/21081545/Safety_and_efficacy_of_CURB65_guided_antibiotic_therapy_in_community_acquired_pneumonia_ L2 - https://academic.oup.com/jac/article-lookup/doi/10.1093/jac/dkq426 DB - PRIME DP - Unbound Medicine ER -