Empiric management of community-acquired pneumonia in Australian emergency departments

Med J Aust. 2005 Nov 21;183(10):520-4. doi: 10.5694/j.1326-5377.2005.tb07153.x.


Objective: To describe empiric community-acquired pneumonia (CAP) management in Australian hospital emergency departments (EDs) and evaluate this against national guidelines, including use of the pneumonia severity index and antibiotic selection.

Design: A multicentre, cross-sectional, retrospective audit, April 2003 to February 2005.

Setting: 37 Australian hospitals: 22 principal referral hospitals, six large major city hospitals, four large regional hospitals, four medium hospitals and one private hospital.

Participants: Adult patients with a diagnosis of CAP made in the ED. Data on 20 consecutive CAP ED presentations were collected in participating hospitals.

Outcome measures: Documented use of the pneumonia severity index, initial antibiotic therapy prescribed in the ED, average length of stay, inpatient mortality, and concordance with national guidelines.

Results: 691 CAP presentations were included. Pneumonia severity index use was documented in 5% of cases. Antibiotic therapy covering common bacterial causes of CAP was prescribed in 67% of presentations, although overall concordance with national guidelines was 18%. Antibiotic prescribing was discordant due to inadequate empiric antimicrobial cover, allergy status (including contraindication to penicillin), inappropriate route of administration and/or inappropriate antibiotic choice according to recommendations. There was no significant difference between concordant and discordant antibiotic prescribing episodes in average length of stay (5.0 v 5.7 days; P = 0.22) or inpatient mortality (1.6% v 4.1%; chi2 = 1.82; P = 0.18).

Conclusions: Antibiotic therapy for CAP prescribed in Australian EDs varied. Concordance with national CAP guidelines was generally low. Targeted interventions are required to improve concordance.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Australia
  • Community-Acquired Infections / classification
  • Community-Acquired Infections / drug therapy*
  • Contraindications
  • Cross-Sectional Studies
  • Emergency Service, Hospital*
  • Female
  • Hospital Mortality
  • Hospitals, District
  • Hospitals, Private
  • Hospitals, Urban
  • Humans
  • Length of Stay
  • Male
  • Medical Audit
  • Middle Aged
  • Penicillins
  • Pneumonia / classification
  • Pneumonia / drug therapy*
  • Practice Guidelines as Topic
  • Retrospective Studies


  • Anti-Bacterial Agents
  • Penicillins