Time to first antibiotic dose for CAP has recently received significant attention from a quality-of care perspective. This emphasis is based on 2 large retrospective studies of Medicare beneficiaries that demonstrated statistically significantly lower mortality among patients who received early antibiotic therapy (Meehan, Houck). The initial study by Meehan demonstrated a 15% relative reduction in 30-day mortality when antibiotics were administered within a 8 hours of arrival, whereas the subsequent analysis by Houck et al found that delivery of antibiotics within 4 hours was associated with lower mortality 30-day mortality (15% relative reduction). The studies differed in that Houck and colleagues excluded patients who were on antibiotics prior to hospital arrival. Several small prospective studies that document the time to first antibiotic dose do not consistently demonstrate this reduction in 30-day mortality, although none had as large a patient population as those in the studies of Meehan and Houck. The IDSA/ATS guideline committee did recommend that antibiotic therapy should be administered as soon as possible after the diagnosis of pneumonia is considered likely and specifically state that delivery of first antibiotic dose would be expected within 6–8 h of presentation whenever the admission diagnosis is likely CAP.

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• American Lung Association
• National Institue of Allergy and Infectious Diseases - National Institutes of Health

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• Bartlett JG, Dowell SF, Mandell LA, et al. Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America. Clin Infect Dis. 2000;31:347-382.
• Bratzler, DW, Houck PM, Nsa W, et al. Initial processes of care and outcomes in elderly patients with pneumonia. {abstract} American College of Emergency Physicians Research Forum, October 15, 2001, Chicago, IL.
• Heffelfinger JD, Dowell SF, Jorgensen JH, Klugman KP, Mabry LR, Musher DM, Plouffle JF, Rakowsky A, Schuchat A, Whitney C and the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group, “Management of Community-Acquired Pneumonia in the Era of Pneumococcal Resistance: A Report From the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group.” Archives of Internal Medicine, 160:1399-1408, May 22, 2000.
• Houck PM, Bratzler DW, Nsa W, et al. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Archives of Internal Medicine, 2004; 164: 637-644.
• Khan KL, Rogers WH, Rubenstein LV, et al. Measuring quality of care with explicit process criteria before and after implementation of the DRG-based prospective payment system. JAMA. 1990:264:1969-1973.
• Mandell LA, Bartlett JG, Dowell SF, et al. Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America. Clin Infect Dis. 2003;37:1405-1433.
• Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Infectious Diseases Society of America/American Thoracic Society. Clin Infect Dis. 2007;44:S27-72.
• McGarvey RN, Harper JJ. Pneumonia mortality reduction and quality improvement in a community hospital. Qual Rev Bull. 1993;19:124-130.
• Meehan TP, Fine MJ, Krumholz HM, et al. Quality of care, process and outcomes in elderly patients with pneumonia. JAMA. 1997;278:2080-2084.
• Niederman MS, Mandell LA, Anzueto A, et al. Guidelines for the management of adults with community-acquired pneumonia. American Thoracic Society. Am .J. Respir. Crit. Care Med. 2001;163:1730-1754.

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