PURPOSE: The Philippine College of Chest Physicians, Philippine Society for Microbiology and Infectious Disease and the Philippine Academy of Family Physicians jointly released in 2004 a “Guideline for the Diagnosis, Empiric Management and Prevention of Community Acquired Pneumonia (CAP)”. This local guideline has never been validated. We proceeded to determine whether patients admitted and diagnosed to have CAP in our institution are managed according to guidelines and whether adherence affects hospital outcomes of these patients.
METHODS: Retrospective cohort of patients > 16 years old with CAP from January 1, 2005 to June 30, 2005. Patients were risk-stratified according to the guidelines. Therapy was considered guideline concordant if it agreed with the recommended therapeutic regimen for that specific classification. Outcomes measured were mortality, use of mechanical ventilation and length of hospital stay.
RESULTS: A total 238 patients were included in the study. Only 47% of patients in the study population were managed according to the guidelines. Mortality was significantly higher for patients whose management was not adherent with guidelines (7.9% vs. 0.9%, p=0.01). Over-treatment with antibiotics did not significantly change mortality (1.4% vs. 0.01%, p =<0.001). Receiving inappropriate treatment (15.1% vs 0.01%, p=<0.001) or an inappropriate dose of the medication (30% vs. 0.01%, p=<0.001) increased mortality. Non-adherent management was associated with more frequent use of mechanical ventilation (11.7% vs 2.7%, p=0.008). Length of hospital stay was not significantly shorter for the adherent group (5.5 ± 4.6 vs. 7.13 ± 6, p=0.64).
CONCLUSION: Majority of physicians at our institution are not adherent to the local guidelines. Adherence to local Philippines management guidelines on CAP improves survival and decreases the frequency of mechanical ventilatory support.
CLINICAL IMPLICATIONS: This study validates the Philippine guidelines in the local setting. A focused and concerted effort for dissemination and adherence of the said guidelines by the medical societies is needed.
DISCLOSURE: Albert Rafanan, None.