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Clinical Evaluation of the Management of Community-Acquired Pneumonia by General Practitioners in France^*

Bruno Fantin, MD; Jean Pierre Aubert, MD; Philippe Unger, MD; Hervé Lecoeur, MD and Claude Carbon, MD

^* From the Institut National de la Santé et de la Recherche Médicale EMI9933, and Service de Médecine Interne, Hôpital Beaujon (Dr. Fantin), Clichy; Société de Formation Thérapeutique du Généraliste (Dr. Aubert), Paris; EURAXI (Dr. Unger), Truyes; MEDILOG (Dr. Lecoeur), Roissy CDG; Institut National de la Santé et de la Recherche Médicale, EMi9933, and Service de Médecine Interne, hôpital Bichat (Dr. Carbon), Paris, France. A list of the general practitioners who included patients in the study is given in the ^Appendix.

Correspondence to: Bruno Fantin, MD, Service de Médecine Interne, Hôpital Beaujon, 100 boulevard du général Leclerc, 92118 Clichy Cedex, France; e-mail: bruno.fantin{at}bjn.ap-hop-paris.fr

Study objectives: To evaluate the management of community-acquired pneumonia (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 by 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 severity of the pneumonia. The remaining 117 patients were treated as outpatients: 108 of 117 patients (92%) were cured, and 9 patients were subsequently hospitalized because of the failure of ambulatory treatment. Diagnostic error (n = 6) rather than antibiotic failure (n = 3) was the most frequent cause of the failure of ambulatory treatment. Only 40% of the patients received an initial antibiotic treatment that was in agreement with French recommendations. However, the rate of antibiotic failure leading to hospitalization 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%) died; all deaths occurred during hospitalization and were related to the severity of the underlying disease but not to the choice of antibiotic treatment.

Conclusions: The management of CAP by GPs was clinically effective despite a poor adherence to official recommendations. Our results suggest that adequate assessment of severity rather than adherence to recommendations for antibiotic treatment had an impact on clinical outcome of CAP managed by GPs.

Key Words: antibiotics • community • health planning guidelines • pneumonia

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