2026 Eastern States Conference

Authors
Jae Sohn, PharmD 
Daryn Norwood, PharmD, BCPS 
Eun Jin Park, PharmD, BCPS, BCIDP 
Kelly Hu, PharmD, BCPS 
Nehal Ahmed, PharmD, BCPS 
 
Learning Objective 
To evaluate ceftriaxone and azithromycin duration of therapy for non-severe community-acquired pneumonia and assess the impact of pharmacist education on treatment duration. 
 
Background  
To evaluate the impact of pharmacist-led education on the duration of ceftriaxone and azithromycin therapy for non-severe community-acquired pneumonia. 
 
Methods
This single-center retrospective before-and-after study will include adults who received ceftriaxone and azithromycin for provider-diagnosed community-acquired pneumonia diagnosed at admission or within 48 hours of hospitalization. Patients will be excluded if clinical stability is not achieved within 72 hours, if methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, or Legionella pneumonia is suspected or confirmed, if structural lung disease or immunocompromising conditions are present, or if alternative antibiotics are required. The primary outcome will be the appropriateness of ceftriaxone and azithromycin therapy duration. Secondary outcomes will include total antibiotic duration, combined inpatient and outpatient ceftriaxone and azithromycin duration, 30-day readmission, and Clostridioides difficile infection within 30 days. 
 
Result:
Among 100 patients included (50 pre-intervention, 50 post-intervention), overall appropriateness of ceftriaxone and azithromycin duration increased from 18% to 44% (p=0.0089). Azithromycin appropriateness improved from 38% to 66% (p=0.0089), while ceftriaxone appropriateness increased from 42% to 58% (p=0.161). Mean total antibiotic duration decreased from 6.4 to 5.7 days. Mean ceftriaxone duration increased from 3.3 to 3.9 days, while mean azithromycin duration decreased from 3.1 to 3.0 days. Thirty-day readmission rates were unchanged between groups, and no 30-day C. difficile infections occurred.
 
Conclusion:
Pharmacist education was associated with improved guideline-concordant antibiotic duration for adults with community-acquired pneumonia, particularly for azithromycin. The greatest improvement was observed among patients with length of stay ≥48 hours, suggesting inpatient stewardship efforts may be most effective when there is sufficient time to intervene. Patients with shorter hospitalizations may benefit from discharge-focused interventions to optimize total antibiotic duration.

Self-Assessment Question:
For clinically stable patients with non-severe community-acquired pneumonia, what is the recommended maximum duration of therapy?
 A. Beta-lactam 5 days and azithromycin 3 days
 B. Beta-lactam 7 days and azithromycin 5 days
 C. Beta-lactam 10 days and azithromycin 5 days
 D. Continue both antibiotics until discharge