Could the early administration of antibiotics before admission improve the prognosis of pneumonia?

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Background: Infectious Diseases Society of America/American Thoracic Society Guidelines on the Management of Community-Acquired Pneumonia 2007 recommend the first antibiotic dose should be administered while still in the emergency department. However, evidence of the benefit of the early administration of antibiotics before admission(EAA) is lacking, and randomized controlled trials are difficult for ethical reasons. Objectives: To clarify the difference in mortality between pneumonia patients who underwent EAA and those who did not, a retrospective cohort analyses using propensity scores were conducted. Methods: Previous cohort patients with pneumonia admitted to our hospital from April 2007 to June 2012 were eligible for this study. The propensity score was calculated using potentially confounding variables to predict the probability of the EAA. The primary outcome was defined as the 30-day mortality. Using the doubly robust estimators (DR) and the inverse probability of treatment weights (IPTW), mortality was estimated using the average treatment effect method. Sensitivity analyses were conducted for the subset of sepsis patients. Results: A total of 1783 pneumonia patients were eligible, including 1227 sepsis patients. The mortalities of the EAA group and the control group were 9.2% and 7.9% (P=.32, unadjusted), 7.8% and 8.7% (P=.58, DR), 7.2% and 8.2% (P=.47, IPTW), respectively. In the subset of sepsis patients, the mortalities were 7.8% and 8.8% (P=.54, DR), respectively. Conclusions: Our analysis suggests that the early administration of antibiotics before admission could not improve the prognosis of pneumonia patients.