Journal
JOURNAL OF EMERGENCY MEDICINE
Volume 37, Issue 3, Pages 335-340Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jemermed.2009.06.127
Keywords
time to first antibiotic dose; CAP; community-acquired pneumonia; pneumonia; antibiotics; emergency department; guideline; evidence-based; quality of care; outcome
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Background: Measurement of time to first antibiotic dose (TFAD) in the emergency department (ED) in community-acquired pneumonia (CAP) has been controversial. Objective: To evaluate original articles reporting outcomes in CAP patients before and after TFAD measurement and assess whether it increases antibiotic overuse in non-CAP conditions. Methods: We performed searches using PubMed, addressing two questions: 1) Is the measurement of TFAD associated with improved outcomes in CAP? and 2) Is the measurement of TFAD associated with antibiotic overuse or interventions that could result in overuse in non-CAP conditions? Two independent reviewers assessed studies addressing these questions. Results: Eight studies were identified. All were Grade C or D and of Adequate quality: two studies supported TFAD by showing improved outcomes (improved survival in one study and no survival difference but shorter hospital length-of-stay in the second) in CAP patients after the implementation of TFAD; one neutral article reported no difference in survival with improved TFAD timing; five studies opposed TFAD either by showing increases in antibiotic overuse in non-CAP patients, or suggesting that TFAD measurement would promote antibiotic misuse. Conclusion: Given inconsistent evidence to demonstrate that improving TFAD in CAP improves outcomes or that TFAD is associated with antibiotic overuse, a Class C indication has been assigned (not acceptable/not appropriate) for ED TFAD measurement. The American Academy of Emergency Medicine recommends that measurement of TFAD in CAP be discontinued. (C) 2009 Elsevier Inc.
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