Appropriateness of empiric antibiotic therapy for community-acquired pneumonia: A multicenter cross-sectional study

Background: Community-acquired pneumonia (CAP) remains a major public health concern, with appropriate empiric antibiotic therapy critical to improving patient outcomes and combating antimicrobial resistance (AMR). Despite the availability of national guidelines, adherence among physicians in Lebanon was previously unclear. Objective: To evaluate the appropriateness of empiric antibiotic prescribing for hospitalized CAP patients in Lebanon and identify factors associated with non-compliance with national guidelines. Methods: A cross-sectional study was conducted in five Lebanese hospitals across various regions. Medical records of 380 adult CAP patients were reviewed. Empiric antibiotic regimens were evaluated for compliance with national CAP guidelines based on drug selection, dosage, route, and duration. Multivariate logistic regression was used to identify predictors of inappropriate prescribing. Results: Only 38.9 % of patients received fully guideline-concordant empiric therapy. Inappropriate prescribing was significantly associated with physician rank (residents: aOR = 29.13, p = 0.001), geographic region (South Lebanon: aOR = 7.78, p = 0.028), and antibiotic class (β-lactam plus respiratory fluoroquinolones: aOR = 19.18, p < 0.001). Clinical factors such as systemic inflammatory response syndrome and elevated serum creatinine were also linked to inappropriate use. Conclusion: Non-compliance with national CAP treatment guidelines is widespread in Lebanese hospitals and driven by physician experience, geographic disparities, and misalignment in antibiotic selection. Strengthening antimicrobial stewardship programs, regional training, and clinical decision support is essential to improve adherence and reduce AMR risk.