The “four hour antibiotic rule” for patients presenting to the hospital with pneumonia has become a mandate from JCAHO and CMS as well as a pay-for-performance initiative. This has caused hospital case managers and administrators to put pressure on ER physicians to jump to a diagnosis of pneumonia. A study presented as a poster abstract (poster 211) at the 2006 IDSA annual meeting demonstrated that the four hour rule is associated with over-diagnosis of pneumonia, evidenced by more diagnoses of pneumonia in patients with negative chest x-rays and a lower percentage of patients initially given antibiotics for pneumonia having the diagnosis confirmed at discharge.
The overuse of antibiotics as a result of the four hour mandate has been demonstrated before as I posted here. The implications concerning breeding antibiotic resistance are obvious.