A prospective study of antibiotic use and clinical factors in patients with suspected pneumonia

This study explored how chest X-ray results influence antibiotic initiation by general practitioners in France when managing patients with suspected pneumonia.

Study approach

A prospective cross-sectional study was conducted with adult patients with suspected pneumonia who received chest X-rays as part of their evaluation. To analyze factors associated with antibiotic initiation, patients' characteristics were compared at inclusion and at 28 days between patients with positive chest X-rays (indicating pneumonia) and patients with negative chest X-ray results.

Main results

The sample included 259 adult patients. The median age was 58 years, 120 (46.3%) were male, 249 (96.1%) had not received antibiotics prior to inclusion, and 69 (26.7%) had at least one risk factor for pneumococcal disease.

• Most of the general practitioners who included patients were women (55.2 %; n = 153), with a median age of 39 years. 76.1% (n = 210) were general practitioner trainers.
• 55.6% of patients (144 out of 259) had positive chest X-ray results.
• Patients with positive chest X-ray results had higher body temperature, faster heart rate, faster breathing rate, more difficulty breathing, and more frequent unilateral chest pain than patients with negative X-ray results, and their symptoms lasted for a longer time.
• 99.3% of patients with positive chest X-ray results received antibiotics. Despite fewer symptoms and negative chest X-ray results, a significant portion (68.75%) of patients with negative chest X-ray results were prescribed antibiotics (79/115 patients).

Why it matters

The findings of this study show that many general practitioners prescribe antibiotics for suspected community-acquired pneumonia even when chest X-ray results are negative, highlighting a gap between guidelines and actual practice.