Medication Outcomes Assessment of Community-Acquired Infections

Abstract

OBJECTIVE: To determine appropriateness of outpatient antibiotic use for common community-acquired infections and to compare the therapeutic outcomes of various antibiotics. DESIGN: Retrospective chart review using a standardized data collection form. PATIENTS: 209 members of a mixed-model health maintenance organization in Tampa, Florida, who had received antibiotics during January 1996. The study population proportionately represented all patients who were prescribed antibiotics, so that severity of illness did not affect results. MAIN OUTCOME MEASURES: This study gauged the appropriateness of empiric therapy based on patient characteristics, infection site, and laboratory/culture results. The outcome measures included appropriate empiric therapy based on patient characteristics and site of infection, as well as laboratory test and microbiological culture results. Antibiotic therapy was categorized as successful if one or more of the following criteria applied: absence of symptoms post therapy, no clinical signs of infection, and/or any clinic visit or call. Unsuccessful therapy resulted in the presence of symptoms post therapy infection not clinically resolved, clinic visit or call, development of resistance, change in drug therapy, emergency room visit, and/or hospitalization. RESULTS: Antibiotic therapy was judged appropriate in 67% of patients and successful in 75% of patients. Of 56 patients with unsuccessful therapy courses, none visited an emergency room or was hospitalized. Infection was confirmed in approximately 10% of patients; 50% of patients initially received a broad-spectrum antibiotic. Antibiotic success rates were 85% for amoxicillin/clavulanate, 79.5% for amoxicillin, 69.9% for first-generation cephalosporins, and 47.4% for second-generation cephalosporins. CONCLUSION: Treatment algorithms are needed to provide recommendations for empilic first-line antibiotic therapy of specific infectious diseases. Use of the quality improvement process could reduce the incidence of antibiotic resistance and pharmacy costs.