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How Antibiotics Should be Prescribed to Hospitalized Elderly Patients with Community-Acquired Pneumonia

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Abstract

Elderly patients hospitalized with community-acquired pneumonia (CAP) should be administered antimicrobials in the emergency department prior to transfer to the ward or intensive care unit (ICU). For ward patients, a β-lactam with a macrolide or a respiratory fluoroquinolone alone should be given to cover typical and atypical pathogens. For ICU patients, a β-lactam with either a macrolide or a fluoroquinolone should be given. Other regimens are indicated if methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa is a concern. Patients who are hemodynamically stable and can tolerate oral intake can be considered for switch therapy as well as discharge if other co-morbidities are stable and a safe disposition plan exists. A number of special concerns for the elderly include noting adverse effects from antimicrobials, being watchful of comorbidity exacerbations, and vaccinating for pneumococcus and influenza.

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References

  1. Eurich DT, Marrie TJ, Minhas-Sandhu JK, et al. Ten-year mortality after community-acquired pneumonia. A prospective cohort. Am J Respir Crit Care Med. 2015;192(5):597–604.

    Article  PubMed  Google Scholar 

  2. Osler W. The principles and practice of medicine. 3rd ed. New York: D Appelton and Co; 1899.

    Google Scholar 

  3. Dunn HL. National and mortality data for the United States. Vital statistics of the United States; part 1. Washington D.C.: National Office of Vital Statistics; 1946.

    Google Scholar 

  4. Heron M. Deaths: Leading causes for 2014. National vital statistics reports, vol 65, no 5. Hyattsville: National Center for Health Statistics; 2016.

  5. Agency for Healthcare Research and Quality. Medical expenditure panel survey, 2013 household component summary tables. http://www.lung.org/assets/documents/research/pi-trend-report.pdf.

  6. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(Suppl 2):S27–72.

    Article  CAS  PubMed  Google Scholar 

  7. Meehan TP, Fine MJ, Krumholz HM, et al. Quality of care, process, and outcomes in elderly patients with pneumonia. JAMA. 1997;278(23):2080–4.

    Article  CAS  PubMed  Google Scholar 

  8. Houck PM, Bratzler DW, Nsa W, et al. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med. 2004;164(6):637–44.

    Article  PubMed  Google Scholar 

  9. Lee JS, Nsa W, Hausmann LR, et al. Quality of care for elderly patients hospitalized for pneumonia in the United States, 2006 to 2010. JAMA Intern Med. 2014;174(11):1806–14.

    Article  PubMed  Google Scholar 

  10. Arnold FW, Summersgill JT, Lajoie AS, et al. A worldwide perspective of atypical pathogens in community-acquired pneumonia. Am J Respir Crit Care Med. 2007;175(10):1086–93.

    Article  PubMed  Google Scholar 

  11. Lim WS, Baudouin SV, George RC, et al. Guidelines for the management of community-acquired pneumonia in adults: update 2009. Thorax. 2009;64(Suppl 3):S1–55.

    Article  Google Scholar 

  12. Brown RB, Iannini P, Gross P, et al. Impact of initial antibiotic choice on clinical outcomes in community-acquired pneumonia: analysis of a hospital claims-made database. Chest. 2003;123(5):1503–11.

    Article  PubMed  Google Scholar 

  13. Restrepo MI, Mortensen EM, Waterer GW, et al. Impact of macrolide therapy on mortality for patients with severe sepsis due to pneumonia. Eur Respir J. 2009;33(1):153–9.

    Article  CAS  PubMed  Google Scholar 

  14. Baddour LM, Yu VL, Klugman KP, et al. Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am J Respir Crit Care Med. 2004;170(4):440–4.

    Article  PubMed  Google Scholar 

  15. Weiss K, Low DE, Cortes L, et al. Clinical characteristics at initial presentation and impact of dual therapy on the outcome of bacteremic Streptococcus pneumoniae pneumonia in adults. Can Respir J. 2004;11(8):589–93.

    Article  CAS  PubMed  Google Scholar 

  16. Gleason PP, Meehan TP, Fine JM, et al. Associations between initial antimicrobial therapy and medical outcomes for hospitalized elderly patients with pneumonia. Arch Intern Med. 1999;159(21):2562–72.

    Article  CAS  PubMed  Google Scholar 

  17. Burgess DS, Lewis JS. Effect of macrolides as part of initial empiric therapy on medical outcomes for hospitalized patients with community-acquired pneumonia. Clin Ther. 2000;22:872–8.

    Article  CAS  PubMed  Google Scholar 

  18. Asadi L, Sligl WI, Eurich DT, et al. Macrolide-based regimens and mortality in hospitalized patients with community-acquired pneumonia: a systematic review and meta-analysis. Clin Infect Dis. 2012;55(3):371–80.

    Article  CAS  PubMed  Google Scholar 

  19. Maimon N, Nopmaneejumruslers C, Marras TK. Antibacterial class not obviously important in outpatient pneumonia: a meta-analysis. Eur Respir J. 2008;31(5):1068–76.

    Article  CAS  PubMed  Google Scholar 

  20. Caffrey AR, Morrill HJ, Puzniak LA, et al. Comparative effectiveness of linezolid and vancomycin among a national veterans affairs cohort with methicillin-resistant Staphylococcus aureus pneumonia. Pharmacotherapy. 2014;34(5):473–80.

    Article  CAS  PubMed  Google Scholar 

  21. Peyrani P, Wiemken TL, Kelley R, et al. Higher clinical success in patients with ventilator-associated pneumonia due to methicillin-resistant Staphylococcus aureus treated with linezolid compared with vancomycin: results from the IMPACT-HAP study. Crit Care. 2014;18(3):R118.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ramirez JA, Srinath L, Ahkee S, et al. Early switch from intravenous to oral cephalosporins in the treatment of hospitalized patients with community-acquired pneumonia. Arch Intern Med. 1995;155(12):1273–6.

    Article  CAS  PubMed  Google Scholar 

  23. Halm EA, Fine MJ, Kapoor WN, et al. Instability on hospital discharge and the risk of adverse outcomes in patients with pneumonia. Arch Intern Med. 2002;162(11):1278–84.

    Article  PubMed  Google Scholar 

  24. Ramirez JA, Vargas S, Ritter GW, et al. Early switch from intravenous to oral antibiotics and early hospital discharge: a prospective observational study of 200 consecutive patients with community-acquired pneumonia. Arch Intern Med. 1999;159(20):2449–54.

    Article  CAS  PubMed  Google Scholar 

  25. Arnold FW, LaJoie AS, Brock GN, et al. Improving outcomes in elderly patients with community-acquired pneumonia by adhering to national guidelines: Community-Acquired Pneumonia Organization International cohort study results. Arch Intern Med. 2009;169(16):1515–24.

    Article  PubMed  Google Scholar 

  26. Egger ME, Myers JA, Arnold FW, et al. Cost effectiveness of adherence to IDSA/ATS guidelines in elderly patients hospitalized for community-aquired pneumonia. BMC Med Inform Decis Mak. 2016;16:34.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Rossio R, Franchi C, Ardoino I, et al. Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia. Eur J Intern Med. 2015;26(5):330–7.

    Article  PubMed  Google Scholar 

  28. Corrales-Medina VF, Musher DM, Wells GA, et al. Cardiac complications in patients with community-acquired pneumonia: incidence, timing, risk factors, and association with short-term mortality. Circulation. 2012;125(6):773–81.

    Article  PubMed  Google Scholar 

  29. Ramirez J, Aliberti S, Mirsaeidi M, et al. Acute myocardial infarction in hospitalized patients with community-acquired pneumonia. Clin Infect Dis. 2008;47(2):182–7.

    Article  PubMed  Google Scholar 

  30. Corrales-Medina VF, Suh KN, Rose G, et al. Cardiac complications in patients with community-acquired pneumonia: a systematic review and meta-analysis of observational studies. PLoS Med. 2011;8(6):e1001048.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Perry TW, Pugh MJ, Waterer GW, et al. Incidence of cardiovascular events after hospital admission for pneumonia. Am J Med. 2011;124(3):244–51.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Clayton TC, Thompson M, Meade TW. Recent respiratory infection and risk of cardiovascular disease: case–control study through a general practice database. Eur Heart J. 2008;29(1):96–103.

    Article  PubMed  Google Scholar 

  33. Torres A, Sibila O, Ferrer M, et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response a randomized clinical trial. JAMA. 2015;313(7):677–86.

    Article  CAS  PubMed  Google Scholar 

  34. Marti C, Grosgurin O, Harbarth S, et al. Adjunctive corticotherapy for community acquired pneumonia: a systematic review and meta-analysis. PLoS One. 2015;10(12):e0144032.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Valley TS, Walkey AJ, Lindenauer PK, et al. Association between noninvasive ventilation and mortality among older patients with pneumonia. Crit Care Med. 2016. doi:10.1097/CCM.0000000000002076. (Epub ahead of print).

  36. Kim DK, Bridges CB, Harriman KH, et al. Advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older: United States, 2016. Ann Intern Med. 2016;164(3):184–94.

    Article  PubMed  Google Scholar 

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Acknowledgements

The author thanks Jessica Lynn Petrey, MSLS, Clinical Librarian, Kornhauser Health Sciences Library, University of Louisville, Louisville, KY, USA, for her critical review.

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  1. Division of Infectious Diseases, School of Medicine, University of Louisville, 501 E. Broadway, Suite 140 B, Louisville, KY, 40202, USA

    Forest W. Arnold

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  1. Forest W. Arnold
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Correspondence to Forest W. Arnold.

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FWA has no conflicts of interest.

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Arnold, F.W. How Antibiotics Should be Prescribed to Hospitalized Elderly Patients with Community-Acquired Pneumonia. Drugs Aging 34, 13–20 (2017). https://doi.org/10.1007/s40266-016-0423-9

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