Management of Community Acquired Pneumonia in a Teaching Hospital: The Role of Established Guidelines


1 Pharmaceutical Care Unit, NRITLD, Shaheed Beheshti University of Medical Sciences,

2 Clinical Pharmacy Department, School of Pharmacy, Shaheed Beheshti University of Medical Sciences

3 Clinical Pharmacy Department, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran,

4 College of Pharmacy, University of Colorado, Denver, USA.


Background: In spite of established guidelines developed by the American Thoracic Society (ATS), Infectious Disease Society of America (IDSA) and Centers for Disease Control (CDC), there is no consensus among physicians regarding hospitalization and choice of antibiotics for management of community-acquired pneumonia (CAP). This study was conducted to determine the percentage of patients appropriately assessed for admittance and the antibiotic treatment selections that were in accordance with the established guideline criteria. Materials and Methods: This retrospective chart review study was conducted at the National Research Institute of Tuberculosis and Lung Disease (NRITLD), Masih Daneshvari Hospital during 2005-2006. Patients with a definite diagnosis of CAP were selected and entered the study. The previous IDSA, ATS and CDC guidelines and the more recent IDSA/ATS CAP guidelines were all used to evaluate the management of patients admitted with CAP. Patients were excluded if information was not sufficient. Results: A total of 31 patients were reviewed. Of the 31 patients included in the study, 24 (77%) could have been treated with outpatient regimens. Six of 31 cases (19%) had been treated with regimens consistent with all three (IDSA, ATS, and CDC) guidelines. Twelve of 31 cases (39%) had corresponded to the previous treatment recommendations from ATS. The management of the remaining 13 patients (42%) had not corresponded to any of the mentioned guidelines. When compared to the recently published joint guidelines of ATS/IDSA, 12 of 31 cases (39%) had appropriately corresponded to the treatment recommendations. Conclusion: According to this study only one fifth of the cases reviewed could have been treated on an inpatient basis. Considering the standard guidelines 42% of the patients did not follow the recommendations from evidence-based guidelines. The enforcement of guideline usage through education and surveillance in university hospital settings may be required. We suggest the use of evidence-based medicine in the treatment of CAP. (Tanaffos 2007; 6(2): 32-37)