Treatment of lower respiratory tract infections
The guidelines recommend penicillin as the drug of choice for non-severe community-acquired pneumonia. For severe pneumonia, penicillin in combination with an aminoglycoside or cefotaxime are recommended.
In cases of exacerbation of COPD, amoxycillin and ampicillin are also recommended (4). Despite this, in this survey we found a considerable prescribing of third-generation cephalosporins and piperacillin with an enzyme inhibitor for treatment of community-acquired lower respiratory tract infections. The frequent prescribing of third-generation cephalosporins may be due to the fact that the guidelines can be perceived as recommending cefotaxime as equivalent to penicillin in combination with aminoglycosides as the drugs of choice for severe pneumonia.
The proportion of patients with severe pneumonia in this survey is unknown. In a Norwegian study from 2016, the proportion of patients with severe pneumonia amounted to 8 – 10 % (12). This is significantly lower than the proportion of patients who received broad-spectrum antibiotics as treatment for a lower respiratory tract infection in this survey.
The guidelines recommend piperacillin with an enzyme inhibitor as an alternative, and not as a first choice, for treatment of ventilator-associated pneumonia, severe aspiration pneumonia or suspicion of multidrug-resistant bacteria (4). The proportion of patients with these indications in this study is unknown, but they commonly account for a small minority of all patients with infections in the lower respiratory tract (2, 12).
For healthcare-associated pneumonia, either penicillin (in combination with aminoglycoside) or cefotaxime are recommended. The proportion of patients who received broad-spectrum antibiotics was significantly higher in the treatment of lower respiratory tract infections that were healthcare-related, rather than community-acquired. Accordingly, the use of broad-spectrum antibiotics may be reduced by preventing infections in the lower respiratory tract. One study has claimed that at least 20 % of all healthcare-associated infections are likely to be preventable (13).
This analysis indicates that the use of broad-spectrum antibiotics against infections in the lower respiratory tract in Norwegian hospitals can be reduced.