The four hour antibiotic rule for pneumonia

Today’s Hospitalist has an update on antibiotic timing rules for pneumonia including the move by CMS and Joint Commission toward a six hour rule. Such a concession, in my view, will do little to alleviate the unintended consequences. The new IDSA guidelines have no timing rule, merely stating that antibiotics should be given as soon as possible in the ER.

The update mentions another problem with timing rules that has avoided the radar screen:

There is also the unproven but widely rumored suspicion that at least some emergency departments triage to favor potential pneumonia patients—even over individuals with other serious illnesses—so they will do well on publicly reported measures.

Yikes.