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February 17, 2020

Overuse of Broad-Spectrum Antibiotics for Pneumonia

Author Affiliations
  • 1Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
  • 2Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Intern Med. 2020;180(4):485-486. doi:10.1001/jamainternmed.2019.7251

The prevailing practice in many hospitals is to give immediate, often broad-spectrum, antibiotics to all hospitalized patients with possible infections. Two interlinked factors drive this practice: (1) clinicians fear that any delay in appropriate antibiotics may increase patients’ risk for worse outcomes including death, and (2) it is uncomfortable to withhold antibiotics from a patient who may have an infection, even if the likelihood of infection is low; doing something feels more responsive, responsible, and patient-centric than doing nothing. The net result, however, is widespread use of antibiotics, much of which is unnecessary. Overprescribing is particularly pronounced in patients with pneumonia. Study after study has documented high rates of pneumonia overdiagnosis, suggesting a rush to treat despite equivocal evidence of disease. Up to half of hospitalized patients treated for pneumonia may not actually have pneumonia.1,2

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    1 Comment for this article
    SEP-1 bundle drive antibiotic overuse
    Amit Desai, HOSPITALIST | Non for profit Hospital
    Wonderful editorial on harm's of broad spectrum coverage of patients with pneumonia. Unfortunately, a driving force behind antibiotic prescribing not mentioned in the article is SEP-1 mandate that pushes for a time sensitive bundled care for severe sepsis. Despite lack of evidence of any such bundle to improve outcome such protocol based care is not only pushed for by CMS but now has become a corporate mandate with incredible amount of investment of dollars to set up an infrastructure that forces compliance. There is a financial penalty for physicians in many organizations for not diagnosing patients to be sick from severe sepsis. Unfortunately, physicians who overdiagnose severe sepsis most commonly from pneumonia or UTI are financially rewarded putting immense pressure on physicians who have reluctance to comply and would prefer nuance. Many such patients who get exposed to broad spectrum antibiotics for pneumonia are often frail and should be receiving high quality and compassionate end of life care. Unfortunately such discussions are often shelved to make room for compliance with bundles with patient's needlessly dying in an ICU.