Evaluation of Switch Over to Definitive Therapy from Empirical Therapy in Adult Patients Admitted with Lower Respiratory Tract Infections

Abstract

Background: Lower respiratory tract infections (LRTI) are defined as infection of lower respiratory tract which includes bronchitis, bronchiolitis and pneumonia. Antibiotic treatment is one of the main approaches of modern medicine which is used to combat all types of infections. Empirical           antibiotic therapy is initiated to treat patients with LRTI within 24 hours of admission. Benefits includes early treatment, reduced mortality, broad spectrum coverage, reduced hospital stay, prevent complications and time saving. Later, based on clinical condition of patients and culture reports, antibiotics are switched over to definitive therapy. Therefore, the aim of our study is to evaluate the effectiveness of empirical therapy. Objectives: To evaluate the effectiveness of empirical antibiotic therapy in LRTI patients after 48 hours of treatment and to determine the percentage of patients need for switching over to definitive therapy. Methodology: We conducted a prospective observational study for a period of 6 months which includes patients who were diagnosed with LRTI and admitted for atleast 5 days in Siddaganga hospital under Respiratory and General Medicine. Results: A total of 115 patients were included in the study. Higher incidence of LRTI was found in males (54.78%). Majority of the patients were aged between 46-60 years (33.91%). Commonly prescribed antibiotics as empirical therapy was piperacillin + tazobactum (38.26%). Nearly, 88 (76.52%) patients were symptomatically improved with empirical antibiotic therapy. 27 (23.47%) needed switching over from empirical therapy after 48 hours of admission based on culture sensitivity report and clinical response. Most frequent reason for switching over to definitive therapy was poor clinical response (8.69%). Most frequently used definitive therapy was meropenem (37.03%). Conclusion: Our study concludes that, most male patients suffered from LRTI. Empirical antibiotic therapy is effective in most of the patients (76.52%) and only 23.47% are switched over to definitive therapy. A Clinical pharmacist helps in ensuring timely and appropriate de-escalation, minimizing resistance, reducing side effects and improving patient outcome in LRTI management.