Poor adherence to South African guidelines for the management of community-acquired pneumonia

Objective. To evaluate adherence to the South African guidelines for the management of community-acquired pneumonia (CAP) and to determine whether adherence reduced length of hospital stay and mortality in patients with severe CAP. Setting. King Edward VIII Hospital, Durban. Methods. Four hundred and thirty patients with CAP were recruited between June 2000 and October 2001. Severity assessment data were collected. Severe CAP was defined by the presence of two or more markers. Without influence from the investigators, the admitting team chose the empirical antibiotic regimen. Antibiotics administered, outcome and length of stay were analysed. Results. Two hundred and eighty-seven of 430 patients were eligible for analysis. One hundred and eighty-two patients had two or more markers of severe CAP. Fourteen of the 182 patients (8%) had initial antibiotic therapy administered according to South African guidelines and 168 (92%) did not. The mortality rate was 20% (36 patients). Accounting for sample size there was no statistically significant difference in length of stay between the two groups (14 v. 12 days, p = 1.0000, odds ratio (OR) 1.167, 95% confidence interval (CI): 0.3926 - 3.467) or in mortality rate (28.5% v. 19%, p = 0.3549, OR 1.667, 95% CI: 0.667 - 4.161). Conclusion. There was very poor adherence with South African CAP antibiotic guidelines. The sample size of patients receiving treatment according to the South African Thoracic Society (SATS) guidelines was too low to confirm confidently that adherence may have resulted in a clinical benefit. South African Medical Journal Vol. 97 (8) 2007: pp. 601-603