Antibiotic treatment of community acquired pneumonia varies widely across Germany

J Infect. 2007 May;54(5):446-53. doi: 10.1016/j.jinf.2006.08.010. Epub 2006 Sep 26.


Community Acquired Pneumonia (CAP) is a frequent and potentially fatal infectious disease which, in the majority of cases, needs an antibiotic intervention.

Objectives: Aim was to evaluate antibiotic treatment patterns regarding all types of mono- and combination-therapy throughout the local clinical centres (LCCs) represented in the German competence network CAPNETZ (=Community Acquired Pneumonia Network) and to identify clinical indicators for regional differences.

Methods: We analysed outpatients and inpatients recruited between March 2003 and April 2005. Patient and treatment details were registered online using standardised data entry forms. A logistic regression model was issued for the 4 most frequently applied antibiotics, adjusting for potentially relevant confounders.

Results: The study sample consisted of 3221 patients at the age of 18 to 102 years. Overall, aminopenicillins plus betalactamase inhibitor (20.4%), fluoroquinolone (17.0%), macrolides combined with cephalosporins third generation (10.6%) and cephalosporins third generation (8.9%) were most frequently prescribed. After control for potential confounders, significant treatment differences remained between study sites. Regional variability of antibiotic CAP-treatment could not be attributed to a number of clinical or sociodemographic factors.

Conclusions: The presented treatment variability ranges within given guidelines, but indicates the need for an ongoing implementation of evidence-based guidelines in order to avoid potential negative clinical or economic consequences.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Cephalosporins / therapeutic use
  • Community-Acquired Infections / drug therapy*
  • Community-Acquired Infections / microbiology
  • Drug Resistance, Bacterial
  • Drug Therapy, Combination
  • Female
  • Fluoroquinolones / therapeutic use
  • Germany
  • Humans
  • Macrolides / therapeutic use
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pneumonia, Bacterial / drug therapy*
  • Pneumonia, Bacterial / microbiology
  • Practice Patterns, Physicians'*
  • Treatment Outcome
  • beta-Lactams / therapeutic use


  • Anti-Bacterial Agents
  • Cephalosporins
  • Fluoroquinolones
  • Macrolides
  • beta-Lactams