Clinical evaluation of the management of community-acquired pneumonia by general practitioners in France

Study objectives: To evaluate the management of community-acquired pneumoni a (CAP) by general practitioners (GPs) in terms of clinical efficiency and adherence to official recommendations. Design: Prospective cohort study. Setting: Community-based study from 11 French counties, Patients: Adult patients clinically suspected of having CAP who were seen b y GPs were included after confirmation of the presence of an infiltrate on chest radiographs, Intervention: The management of the patients was left to the discretion of the GP, Measurements and results: One hundred thirty patients were included in the study, and 13 patients (10%) were immediately hospitalized because of the s everity of the pneumonia. The remaining 117 patients were treated as outpat ients: 108 of 117 patients (92%) were cured, and 9 patients were subsequent ly hospitalized because of the failure of ambulatory treatment. Diagnostic error (n = 6) rather than antibiotic failure (n = 3) M as the most frequent cause of the failure of ambulator) treatment. Only 40% of the patients rec eived an initial antibiotic treatment that was in agreement with French rec ommendations. However, the rate of antibiotic failure leading to hospitaliz ation was low (3 of 117 patients; 2.6%) and similar for patients treated or not according to recommendations (p > 0.5). Overall, five patients (4%) di ed; all deaths occurred during hospitalization and were related to the seve rity of the underlying disease but not to the choice of antibiotic treatmen t, Conclusions: The management of CAP by GPs was clinically effective despite a poor adherence to official recommendations. Our results suggest that adeq uate assessment of severity rather than adherence to recommendations for an tibiotic treatment had an impact on clinical outcome of CAP managed by GPs.