University of Tasmania

File(s) under permanent embargo

Community-acquired pneumonia: why aren’t national antibiotic guidelines followed?

journal contribution
posted on 2023-05-18, 16:21 authored by Almatar, MA, Gregory PetersonGregory Peterson, Angus ThompsonAngus Thompson, McKenzie, DS, Anderson, TL

Aims: v Adherence to guidelines for the management of community-acquired pneumonia (CAP) has been shown to improve patients' clinical outcomes. This study aimed to assess adherence to the Australian Therapeutic Guidelines (TG14) for the empirical management of CAP, and explore the potential barriers affecting adherence to these guidelines.

Methods: Medical records were reviewed for all patients who were diagnosed with CAP within 24 h of presentation at the Royal Hobart Hospital, the main teaching hospital in Tasmania, Australia, between July 2010 and March 2011. A survey of emergency department and medical team prescribers was also undertaken to identify potential barriers to adhere with the guidelines. χ2 and Fisher's exact tests were used to test the significance between categorical data. To compare categorical and scale data, the Mann–Whitney U-test was used.

Results: A total of 193 patient records were assessed. The overall adherence to TG14 for the empirical antibiotic management of CAP was 16.1% (3.1%, 20.7% and 25.4% for patients with mild, moderate and severe CAP, respectively). Ceftriaxone was prescribed to 34.4%, 26.8% and 57.4% of patients with mild, moderate and severe CAP, respectively. The response rate to the barrier survey was 43.1%; of those who responded, 46.4% thought the influence of senior doctors on junior doctors could be a factor affecting adherence to the guidelines. Other barriers noted were a lack of guideline awareness (39.3%), the requirement to calculate the severity of CAP (35.7%), and the existence of other guidelines that conflict with TG14 (28.6%).

Conclusions: Adherence to CAP treatment guidelines was poor, especially in patients with mild disease. Prescribing was mainly influenced by senior doctors. Efforts to improve compliance with CAP treatment guidelines should consider the potential barriers that hinder adherence.


Publication title

International Journal of Clinical Practice








School of Pharmacy and Pharmacology


Blackwell Publishing Ltd

Place of publication

United Kingdom

Rights statement

Copyright 2014 John Wiley & Sons Ltd

Repository Status

  • Restricted

Socio-economic Objectives

Clinical health not elsewhere classified

Usage metrics

    University Of Tasmania


    Ref. manager