Initial Management Of Patients With Community-Acquired Pneumonia In A Tertiary Hospital In Sri Lanka

Introduction: We studied the choice of antibiotic/s prescribed on admission and microbiological investigations, in patients hospitalised with community-acquired pneumonia, and compared such choice with published consensus guidelines.Methods: Adult patients admitted to medical wards of the National Hospital of Sri Lanka with clinical features of pneumonia, with subsequent radiological confirmation, were eligible for inclusion (n=112). Patients who had been in hospital within 10 days of admission, and those with diagnoses of lung malignancy, lung fibrosis, bronchiectasis or tuberculosis were excluded. We obtained data from the patients' case records regarding indicators of severity, the antibiotic prescribed on admission, and route of administration. The microbiological investigations performed were also recorded. We compared the practices with guidelines for management of community-acquired pneumonia published by the British Thoracic Society in 2001.Results: The respiratory rate, a core clinical adverse prognostic feature, was documented in only 13% of case records. Oral amoxicillin was the most common antibiotic prescribed on admission, with 29% of hospitalized patients receiving it. Erythromycin was included in the drug regimen in only 18% of all patients. Intravenous antibiotics were started for 44% of cases without any documented adverse prognostic features on admission. Sputum was sent for acid-fast bacilli staining in 48% of patients and for bacterial culture in 11%. Blood culture was performed in 5% of patients.Conclusion: Documentation of severity criteria is often incomplete. There is inadequate utilization of oral macrolide antibiotics to cover atypical pathogens. Intravenous antibiotics are overused in hospitalized patients with community-acquired pneumonia.