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Recent guidelines for management of community-acquired pneumonia (CAP) call for administering antibiotics within 4 hours of presentation to the emergency department. This standard has become a “quality indicator” for some insurance payers, even though studies disagree on the strength of clinical evidence supporting the policy (Journal Watch Aug 29 2006).
Researchers reviewed CAP admissions to a single Michigan teaching hospital over a 6-month period in 2003 (before the 4-hour guidelines were published), and a similar period in 2005 (a year after publication). Of 518 patients, significantly more received antibiotics within 4 hours in 2005 than in 2003 (66% vs. 54%). However, significantly more also left the hospital with a diagnosis other tha…