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Christine Malcolm, BSc; Thomas J. Marrie, MD

Arch Intern Med. 2003;163:797-802.

Background  Little attention has been paid to the factors that influence choice of antibiotic therapy for patients with community-acquired pneumonia who are treated on an ambulatory basis in an emergency department setting.

Methods  Prospective observational study of all patients who presented to the 6 hospitals for adults in the Capital Health Authority, Edmonton, Alberta, with community-acquired pneumonia (as diagnosed by the emergency department physician) from November 15, 2000, through April 30, 2001, and who were treated on an ambulatory basis.

Results  The study population consisted of 768 patients, mean age 51 years. The antibiotics most commonly prescribed were azithromycin (36%), levofloxacin (32%), and clarithromycin (17%). Site of care differences were evident in the frequency of clarithromycin (P<.001) and levofloxacin (P = .01) prescription. Multiple logistic regression analysis showed that older age, presence of chronic obstructive pulmonary disease, antibiotic therapy at the time of presentation, and site of care were factors independently predictive of levofloxacin use (P<.05 for all factors). Levofloxacin prescription did not follow our indications for its use in 51% of the 245 patients who were treated with this antibiotic. The failure rate (defined as admission to the hospital within 3 weeks of emergency department visit) was low (2.2%).

Conclusions  Patient factors and site of care influence the choice of antibiotic therapy in an ambulatory setting, and 50% of levofloxacin use was inappropriate according to our definition.

From the Department of Medicine (Dr Marrie) and the Medical School (Ms Malcolm), University of Alberta, Edmonton. Dr Marrie has received research grants from Janssen-Ortho, Toronto, Ontario; Pfizer Inc Canada, Montreal, Quebec; and Abbott Laboratories Canada, Montreal, Quebec; as well as honoraria for speaking engagements in the last year from Pfizer and Janssen-Ortho.

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