Overuse of broad-spectrum antibiotics in Pneumonia may lead to worse outcomes

Overuse of broad-spectrum antibiotics in Pneumonia may lead to worse outcomes, finds a new study.

A new study by researchers at Intermountain Healthcare has found that administering broad-spectrum antibiotics, which act against a wide range of disease-causing bacteria, to treat patients with pneumonia often does more harm than good. The study has been published in the European Respiratory Journal.

The study found that broad-spectrum antibiotics are often used in patients who don’t need them, resulting in potential side-effects that lead to complications and longer hospital stays.

“Contrary to popular belief, using broad-spectrum antibiotics when they’re not necessary not only doesn’t improve outcomes but is associated in our study with poor results,” said Brandon J. Webb, MD, lead author of the study and an infectious disease physician at Intermountain Healthcare.

More than 250,000 people in the nation seek care at emergency rooms every year due to pneumonia. Antibiotics are an important part of pneumonia treatment and target the most common bacteria that cause this infection. However, researchers found that using broad-spectrum antibiotics to treat pneumonia work against drug-resistant bacteria that less commonly cause pneumonia, said Dr. Webb.

In the study, researchers identified 1,995 adults who came to four Intermountain Healthcare hospital emergency rooms with community-onset pneumonia, which means they didn’t develop pneumonia while they were in the hospital.

When researchers reviewed these patients, they found that those who received broad-spectrum antibiotics had longer hospital stays, greater costs of care, and increased rates of Clostridioides difficile infection (commonly known as “C. diff”), a type of infectious diarrhea that is a side-effect of antibiotics. They also identified antibiotic-associated events in 17.5 per cent of the patients who passed away.

While antibiotics are powerful tools in healthcare, they do come with some risks, said Dr Webb.

“Antibiotics are not benign,” Dr. Webb noted. “They have side-effects like allergic reactions, anaphylaxis, disorientation and kidney injury, and all of these things can contribute to patients not doing as well.”

Researchers also looked at whether or not broad-spectrum antibiotics were appropriately prescribed to patients and found that 39.7 per cent of patients received them when only three per cent had drug-resistant pathogens that required treatment with the antibiotics.

Dr Webb believes the new study suggests that physicians who prescribe antibiotics should know the kinds of pathogens that cause most pneumonia cases in their area. That way, they’re less likely to prescribe broad-spectrum antibiotics to patients who don’t need them.

Dr Webb said being precise in administrating antibiotics can also combat the growth of antibiotic-resistant bacteria. He suggested that physicians use risk factor profiles to identify which patients are more likely to have an antibiotic-resistant strain, so they know exactly what antibiotic to use and which patients can benefit.

This concept is part of an international movement called “antibiotic stewardship”, which simply means using the right antibiotic for the right infection.

“These results argue strongly for being wise stewards of the antibiotic resources we have,” Dr. Webb said.

The study was funded by the Intermountain Research and Medical Foundation.

Intermountain Healthcare is a Utah-based not-for-profit system of 24 hospitals, 160 clinics, a Medical Group with some 2,300 employed physicians and advanced care practitioners, a health insurance company called SelectHealth, and other health services. Intermountain is widely recognized as a leader in transforming healthcare through evidence-based best practices, high quality, and sustainable costs.