Effectiveness of Early Antibiotic Administration on Outcomes in Pneumonia Patients in Emergency Department

Abstract

Background: Pneumonia remains a major cause of morbidity and mortality worldwide and frequently presents to emergency departments. Early initiation of antibiotic therapy has been proposed as an important factor influencing clinical outcomes in patients with pneumonia; however, delays in treatment remain common in busy emergency care settings, particularly in resource-limited healthcare systems. Objective: To evaluate the association between early antibiotic administration and clinical outcomes among adult patients presenting with pneumonia to the emergency department of a tertiary care hospital. Methods: This prospective observational study was conducted in the emergency department of Lady Reading Hospital–Medical Teaching Institution, Peshawar, Pakistan, from 1 March to 31 July 2025. Adult patients aged ≥18 years presenting with clinically and radiologically confirmed pneumonia were consecutively enrolled. The primary exposure variable was time from emergency department registration to first intravenous antibiotic administration. Patients were categorized into early (≤3 hours) and delayed (>3 hours) antibiotic groups. Outcomes assessed included length of hospital stay, intensive care unit (ICU) admission, and in-hospital mortality. Data were analyzed using SPSS version 26 with appropriate comparative and multivariable statistical methods. Results: A total of 120 patients were included (mean age 56.8 ± 17.4 years; 60% male). Early antibiotic administration occurred in 68 (56.7%) patients. Patients receiving early antibiotics had significantly shorter hospital stays (5.1 ± 2.3 vs 7.4 ± 3.1 days; p=0.01) and lower ICU admission rates (11.8% vs 26.9%; p=0.03). In-hospital mortality was lower in the early antibiotic group (4.4% vs 13.5%), although this difference did not reach statistical significance (p=0.06). Conclusion: Early administration of antibiotics within three hours of emergency department presentation was associated with shorter hospitalization and reduced ICU admission among pneumonia patients. These findings support the importance of timely antimicrobial therapy in emergency department management of pneumonia.