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. 2024 Nov-Dec;22(6):509-517.
doi: 10.1370/afm.3179.

Relation Between Chest Radiography Results and Antibiotic Initiation in Community-Acquired Pneumonia Management by General Practitioners

Juliette Pinot  1   2 , Serge Gilberg  2 , Cédric Laouénan  3   4 , Toni Alfaiate  4 , Marie Ecollan  2 , Fanny Cussac  2 , Raphaël Pecqueur  2 , Marie-Pierre Revel  5   6 , Cyrille Vartanian  7 , Henri Partouche  2 , Xavier Duval #  3   8 , Josselin Le Bel #  3   2
Affiliations

Relation Between Chest Radiography Results and Antibiotic Initiation in Community-Acquired Pneumonia Management by General Practitioners

Juliette Pinot et al. Ann Fam Med. 2024 Nov-Dec.

Abstract

Purpose: For most guidelines, diagnosis of community-acquired pneumonia (CAP) is based on a combination of clinical signs and focal consolidation visible on chest radiographs (CRs). Our objective was to analyze antibiotic initiation by general practitioners for patients with suspected CAP according to CR.

Methods: We conducted a prospective cross-sectional study in general practice in France. From November 2017 to December 2019, adult patients with clinically suspected CAP after CR were included. Radiographs were categorized as CAP positive or CAP negative. We analyzed patient characteristics and antibiotic initiation according to CR results.

Results: A total of 259 patients were included in the study. Median age was 58.0 years (interquartile range, 41.0-71.0 years); 249 (96.1%) patients had not received antibiotics before inclusion, and 144 (55.6%) had a positive CR. Patients with positive CR were clinically more severe than those with negative CR, with longer-lasting symptoms. Antibiotics were initiated for 142/143 (99.3% [95% CI, 97.9%-100.0%]) patients with positive CR and 79/115 (68.7% [95% CI, 60.2%-77.2%]) with negative CR (P < .001). Among the 115 CR-negative patients, clinical characteristics that were significantly different between patients for whom antibiotics were initiated or not did not appear to be clinically relevant.

Conclusions: For patients with suspected CAP, general practitioners systematically took into account results of positive CRs to initiate antibiotics and took much less account of negative CRs. These results justify clarification of what should be done in cases of clinical suspicion of CAP without radiologic confirmation.

Keywords: antibiotics; chest radiography; general practice; pneumonia.

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Figures

Figure 1.
Figure 1.
Flowchart and antibiotic prescription. CAP = community-acquired pneumonia; CR = chest radiography. aIncomplete investigations = patients with suspected CAP who could not have CR within 6 hours either due to unavailability of the radiology office or because they were unable to go to the radiology office. bData missing for 1 patient (n = 143).
See this image and copyright information in PMC

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