Antibiotic choice and patient outcomes in community-acquired pneumonia.

BACKGROUND: We investigated whether any clinical or nonclinical variables were associated with physician choice of antibiotic therapy and whether outcome differences existed among patients given agents to treat infections caused by atypical gram-negative organisms.
METHODS: A retrospective review of 157 immunocompetent patients admitted to a hospital between 1 February 1992 and 31 January 1993 with a diagnosis of community-acquired pneumonia was performed. Patient groups were defined by whether their initial antibiotic therapy was a broader spectrum antibiotic, such as a second- or third-generation cephalosporin, which would treat atypical gram-negative infection (n = 85), or narrower spectrum agents, such as ampicillin or erythromycin (n = 72).
RESULTS: Patients who were given broader spectrum antibiotics were slightly older than those receiving narrower agents (73 versus 66 years, P = 0.06). Otherwise, no clinical factors or comorbid states were associated with antibiotic selection. When examining physician-related factors, internists were more likely to prescribe broad-spectrum agents than were family physicians. No differences existed in overall mortality, length of stay, readmission rate, or change in antibiotic.
CONCLUSIONS: Although physicians appear to prescribe broader agents for pneumonia in older patients, there were no other clinical predictors of antibiotic selection. Physician-related factors, such as training and specialty, might influence prescribing habits.