Evidence Behind the 4-Hour Rule for Initiation of Antibiotic Therapy in Community- Acquired Pneumonia Kenneth T. Yu, MD, MBA, Peter C. Wyer, MD Annals.

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Presentation transcript:

Evidence Behind the 4-Hour Rule for Initiation of Antibiotic Therapy in Community- Acquired Pneumonia Kenneth T. Yu, MD, MBA, Peter C. Wyer, MD Annals of Emergency Medicine Volume 51, Issue 5, Pages 651-662.e2 (May 2008) DOI: 10.1016/j.annemergmed.2007.10.022 Copyright © 2008 American College of Emergency Physicians Terms and Conditions

Figure 1 Process of selecting included studies (completed August 21, 2006). Annals of Emergency Medicine 2008 51, 651-662.e2DOI: (10.1016/j.annemergmed.2007.10.022) Copyright © 2008 American College of Emergency Physicians Terms and Conditions

Figure 2 4-hour time to antibiotics versus mortality. Forest plot of studies reporting inpatient or 30-day mortality in patients with community-acquired pneumonia receiving antibiotics within 4 hours compared to patients receiving antibiotics later than 4 hours. Odds ratios and 95% confidence intervals (CIs) are provided for each study, with the round dots representing the point estimates and the horizontal lines the CIs. Studies identified as A, B, C and D correspond to uncontrolled retrospective studies, controlled retrospective studies, uncontrolled prospective studies and controlled prospective studies, respectively. The adjusted OR for the study by Silber was calculated by the authors. *severity-adjusted using Pneumonia Severity Index (PSI). Annals of Emergency Medicine 2008 51, 651-662.e2DOI: (10.1016/j.annemergmed.2007.10.022) Copyright © 2008 American College of Emergency Physicians Terms and Conditions

Figure 3 8-hour time to antibiotics versus mortality. Forest plot of studies reporting inpatient or 30-day mortality in patients with community-acquired pneumonia receiving antibiotics within 8 hours compared to patients receiving antibiotics later than 8 hours. Odds ratios and 95% confidence intervals (CIs) are provided for each study as in Figure 2. Studies are categorized (A, B, C and D) as in Figure 2. *severity-adjusted using Pneumonia Severity Index (PSI). Annals of Emergency Medicine 2008 51, 651-662.e2DOI: (10.1016/j.annemergmed.2007.10.022) Copyright © 2008 American College of Emergency Physicians Terms and Conditions