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Can Patients with Pneumonia Take Their Antibiotics at Home? FREE

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The summary below is from the full report titled “Outpatient Care Compared with Hospitalization for Community-Acquired Pneumonia. A Randomized Trial in Low-Risk Patients.” It is in the 1 February 2005 issue of Annals of Internal Medicine (volume 142, pages 165-172). The authors are J. Carratalà, N. Fernández-Sabé, L. Ortega, X. Castellsagué, B. Rosón, J. Dorca, A. Fernández-Agüera, R. Verdaguer, J. Martínez, F. Manresa, and F. Gudiol.

Ann Intern Med. 2005;142(3):I-30. doi:10.7326/0003-4819-142-3-200502010-00002
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What is the problem and what is known about it so far?

Pneumonia is an acute infection of the lung that is often treated with antibiotics. Most patients with pneumonia have symptoms such as shortness of breath, fever, or chest pain. Most get better once treatment begins, but some patients develop serious complications and some die of the infection. Factors that increase the chance of dying of pneumonia include older age, living in a nursing home, having other illnesses (especially cancer), and having certain abnormal physical examination or test results. Experts agree that patients at high risk for dying of pneumonia should be hospitalized for observation and treatment. Patients at low risk for dying may need less close observation and may be able to take antibiotics at home.

Why did the researchers do this particular study?

To see if treating low-risk patients with pneumonia at home is as effective and safe as treating them in the hospital.

Who was studied?

203 patients who received diagnoses of pneumonia in the emergency departments of 2 hospitals in Spain between 2000 and 2002. A commonly used scoring system based on patient factors (the Pneumonia Severity Index) showed that all had a low risk for dying.

How was the study done?

The researchers randomly assigned the patients to receive antibiotics at home or in the hospital. Thirty days later, they compared treatment success and safety, patient quality of life, and patient satisfaction in the 2 groups. The researchers considered treatment successful if the symptoms, signs, and x-ray findings of pneumonia went away without a change in antibiotics. The researchers considered treatment safe if the patients did not have side effects from the antibiotics and did not get complications from the infection during or after treatment.

What did the researchers find?

About 80% of the patients in both groups improved without side effects, complications, or the need to change antibiotics. About 10% in both groups had some type of side effect from the antibiotic. Patient quality of life did not differ between the groups. Patients treated at home were more satisfied with their overall care than were patients hospitalized for treatment.

What are the limitations of the study?

The study included too few patients for the researchers to see if the different treatment approaches might affect numbers of deaths. Many patients who were classified as low risk were not included in the study. Most of these had problems with breathing (low oxygen levels) that the doctors thought needed to be treated in the hospital.

What are the implications of the study?

Low-risk patients with pneumonia who have adequate oxygen levels can safely take their antibiotics at home. Patients are more satisfied with home treatment.





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