Treatment of nursing home-acquired pneumonia – Tips from Other Journals
Nursing home-acquired pneumonia is a common problem that is traditionally treated in a hospital setting, resulting in large health care expenditures. Phillips and Branaman-Phillips evaluated whether nursing home treatment with either intramuscular cefoperazone or ceftriaxone is a safe and effective alternative to treatment in the hospital.
The study included 104 nursing home residents aged 65 years or older. Patients were included in the study if they had bacterial pneumonia, which was defined by (1) the presence of new infiltrates on radiographic examination compatible with pneumonia and (2) at least three of the following: purulent sputum and/or a positive sputum culture, rectal temperature greater than 38.2 [degrees] C (100.8 [degrees] F), peripheral white blood cell count greater than 10,500 per [mm.sup.3] (10.5 x [10.sup.9] per L), cough or a positive blood culture. A resident was excluded from the study if he or she was terminally ill, was allergic to cephalosporins, required concomitant antibiotic therapy, had a neutrophil count of less than 1,000 per [mm.sup.3] (1.0 X [10.sup.9] per L), had a contraindication to intramuscular therapy or was hypotensive or required ventilatory support. Patients were randomly assigned to receive a 10-day course of either cefoperazone (1 g intramuscularly every 12 hours) or ceftriaxone (1 g intramuscularly once every 24 hours).
Among the 54 patients who received ceftriaxone, 51 (94 percent) had a clinical cure. Among the 50 patients who received cefoperazone, 45 (90 percent) had a clinical cure. Streptococcus pneumoniae was the most commonly identified bacterial isolate. All of the isolates identified were susceptible to both cefoperazone and ceftriaxone. Both groups showed partial resolution of infiltrate on radiologic examination at follow-up 30 to 45 days after completion of antibiotic treatment. No adverse experiences were reported.
The authors conclude that intramuscular cefoperazone or ceftriaxone is safe and cost-effective in the treatment of nursing home-acquired pneumonia; cost of the 10-day treatment was estimated at $280. Also, the mortality rate was 4.5 percent lower than the rate reported in similar studies. The authors attribute this result to early diagnosis, as well as treatment by staff who knew the residents and cared for them on a daily basis, thereby decreasing the possibilities for disorientation, combativeness and iatrogenic complications. They suggest that in nursing home facilities with adequate 24-hour monitoring by nursing staff, laboratory services, an oxygen supply, a well-stocked pharmacy, and a physician or mid-level provider to evaluate the patient daily, hospitalization for nursing home-acquired pneumonia may be avoided.
COPYRIGHT 1994 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group