The aim of this descriptive research was to study use of antimicrobials, type of pathogens and their susceptibility, and drug-related problems in inpatients with pneumonia at Phramongkutklao Hospital from October 2000 to January 2001. Fifty-two patients with the mean age of 65.8+-19.8 years were diagnosed as community-acquired pneumonia (CAP), while fifty-eight patients with the mean age of 63.1+-19.2 years were diagnosed as hospital-acquired pneumonia (HAP). No statistically significant difference of mean age was found between groups (p-value = 0.464). Length of stay and duration of antimicrobial use in the two groups were significantly different (p-value = 0.000). Culture tests were performed in 50 CAP patients and 57 HAP patients. The top two pathogens found in CAP patients were K.pneumoniae and P.aeruginosa (each of 25.0%). The culture results were not consistent with gram stain which gram positive cocci was mostly found, thus the results obtained from culture might not be the true pathogens. k.pneumoniae was equally susceptible at 100% to amoxicillin/clavulanic acid, cephalosporin, aminoglycoside, carbapenem, and fluoroquinolone. Patients with K.pneumoniae were mostly prescribed penicillin/penicillinase inhibitors (62.5%) as empirical treatment. The top three pathogens found in HAP patients were P.aeruginosa, MRSA, and S.maltophilia at the rate of 29.1, 18.5, and 14.6%, respectively. P.aeruginosa was equally susceptible to meropenem and netilmicin (88%), and susceptible to amikacin and ceftazidime at 79 and 67%, respectively. MRSA was 100% susceptible to chloramphenical and glycopeptides group. Ceftazidime was prescribed as empirical treatment to most of HAP patients with P.aeruginosa, whereas piperacillin/tazobactam and ceftriaxone were equally prescribed at the second rank. Most of CAP patients (42.5%) were given empirical treatment with penicillin/penicillinase inhibitors and 17.3% with the third generation cephalosporin, while most of HAP patients wer given empirical treatment with beta-lactam/beta-lactamase inhibitors (22.4%). No treatment was changed in 78.0% of CAP patients after obtaining culture and susceptibility results whereas the treatment of 66.7% of HAP patients was changed, especially in the type of antimicrobials. Penicillin/penicillinase inhibitors were most prescribed as discharged medication to CAP patients with average duration of 8.76 days. Most of HAP patients were not prescribed discharged medication and 37.9% of them died. Total number of 48 drug-related problems were identified in 36 patients and classified as 85.4% of drug prescribing, 2.2% of discharged-drug prescribing, and 12.5% of adverse drug reactions. However, the effect of these problems on outcomes of treatment was not clearly demonstrated.
