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Antimicrobials Prescription Pattern in Outpatient Adults with Community-Acquired Pneumonia

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S.N. Kozlov 1, S.A. Ratchina 1, N.P. Domnikova 2, O.I. Karpov 3, V.B. Kuzin 4, I.V. Leschenko 5, R.J. Likhatchova 6, S.V. Nedogoda 7, L.S. Stratchounski 1

1 Institute of Antimicrobial Chemotherapy, Smolensk State Medical Academy, Smolensk, Russia
2 Novosibirsk State Medical Academy, Novosibirsk, Russia
3 Institute of Pharmacology, S.-Petersburg State Medical University named under I.P. Pavlov, S.-Peterburg, Russia
4 Nizjni Novgorod State Medical Academy, Nizjni Novgorod, Russia
5 Ekaterinburg Clinical Hospital N 33, Ekaterinburg, Russia
6 Oupatient department N 7, Moscow, Russia
7 Volgograd State Medical Academy, Volgograd, Russia

Case histories of outpatients with community-acquired pneumonia (CAP) who had not required hospitalization were randomly selected in seven regions of Russia for retrospective analysis. Diagnoses were classified according to the ICD-10; antimicrobials – to the ATC classification.

Altogether 778 case histories of patients aged from 16 to 88 (average age 47,1±17,2) were included in the study. The most frequently prescribed group of medications were antimicrobials for systemic use (99,5%), anti-cough and anti-inflammatory preparations (75,5%), vitamins (24,0%) and antihistamines (23,4%). In 71,4% of cases antimicrobials were administered orally, in 28,6% – parenterally. The most common antimicrobial prescribed was gentamycin (29,3%), followed by co-trimoxazole (22,7%), ampicillin (20,3%) and ciprofloxacin (17,2%).

For initial antimicrobial treatment monotherapy was used in 83,6% of cases (gentamycin in 18,7%, ampicillin – 14,5%, ciprofloxacin – 12,5). Combination of 2–3 antibiotics as initial therapy received 16,4% of patients; the most frequently prescribed combinations were ampicillin + co-trimoxazole (24,4%) and gentamycin + co-trimoxazole (8,7%). Average duration of antimicrobial therapy was 9,9±4,7 days.

Unacceptably large number of various antibiotics was used for treatment of CAP. Most of the "popular" antibiotics are not recommended for empirical therapy by the current guidelines. Further studies are advisable to clarify the reasons for such prescription habits.

Key words: community-acquired pneumonia, antimicrobial therapy, pharmacoepidemiology.

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