Does guideline adherence have a positive impact on the outcome of community-acquired respiratory tract infection?

Community-acquired respiratory tract infections (CA-RTIs) are a common reason for the presentation of patients for medical care, during which an antibiotic is commonly prescribed, and these infections are associated with considerable morbidity and/or mortality. Clinical practice guidelines have been developed in many parts of the world, with the aim of improving the overall quality of care in order to achieve the best patient outcomes. However, despite reviewing similar evidence, there are discrepancies in the antibiotic recommendations of guidelines from different parts of the world, which may relate either to differences in the interpretation of the same evidence base, or to local differences in the epidemiological aspects of the various infections. Importantly, in order to ensure that the guidelines are effective, there is a need to evaluate the levels of adherence to the specific guideline recommendations, as well as to determine whether guideline adherence is associated with improved patient outcomes. In general, studies have clearly documented that there are relatively poor levels of adherence to the antibiotic recommendations of the various guidelines. In the case of upper respiratory tract infections (URTIs), there tends to be overuse of antibiotics, in general, with the prescription of a much broader spectrum of agents than is commonly required. Furthermore, since the overall benefit of antibiotics in URTIs is relatively small, it is usually difficult to document an improvement in patient outcomes with antibiotic adherence. The evidence in the case of lower respiratory tract infections is much more clear-cut. While generally the levels of adherence to the antibiotic recommendations also tend to be rather low, there is evidence in sicker patients, such as those with severe exacerbations of chronic obstructive pulmonary disease and in cases with community-acquired pneumonia, including the elderly and critically ill patients, that adherence to the guideline recommendations is clearly associated with improved outcomes. Among these benefits is improved patient survival, shorter times to clinical stability, time to switch therapy, and length of hospital stay, and also evidence of improved cost effectiveness of care. All these issues will be addressed in the current presentation.