The Cleveland Clinic https:/my.clevelandclinic.org has received a $2.5 million grant from AHRQ to conduct a multicenter clinical trial to evaluate ways to reduce the use of broad spectrum antibiotics in adult patients with community-acquired pneumonia.
The five year grant led by Michael Rothberg, MD, Vice Chair of the Cleveland clinic Community Care, and Abhishek Deshpande, MD, PhD, a Staff Physician in the Center for Value-Based Care Research, will conduct the largest randomized trial to determine the impact of rapid diagnostic testing on antibiotic use in adult patients with community-acquired pneumonia.
Treatment for pneumonia should be determined by the cause. Antibiotics should be used for bacterial pneumonia, and antiviral drugs for influenza and COVID-19, and antifungal medication for fungi. Since most patients are not tested for the cause, they are usually treated with antibiotics that may be used for long periods of time which may not be necessary.
The trial will test limiting the use of antibiotics in hospitalized patients by studying the routine use of rapid diagnostic testing at the time of hospital admission, but also providing for pharmacist-led de-escalation by stopping or changing the antibiotics to target a specific bacteria after 48 hours for clinically stable patients who test negative for bacterial pneumonia.
Knowing what type of pathogen is causing a patient’s pneumonia could allow physicians to begin with a more targeted therapy which would help avoid unnecessary antibiotics. It is important to understand when patients do not have a resistant bacteria so they can receive standard antibiotic therapy for most of their hospital stay which may help the patient avoid complications that can come with stronger antibiotics.