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Antibiotic Treatment of Children Hospitalized with Pneumonia

December 4, 2013

Antibiotic Treatment of Children Hospitalized with Pneumonia

  1. Louis M. Bell, MD

Clinical outcomes associated with narrow-spectrum antibiotics and broad-spectrum antibiotics were equivalent.

  1. Louis M. Bell, MD

In 2011, the Pediatric Infectious Diseases Society guidelines for management of community-acquired pneumonia (CAP) in infants (age >3 months) and children recommended use of narrow-spectrum antibiotics for outpatient (e.g., amoxicillin) and inpatient (e.g., ampicillin) management of uncomplicated CAP. Researchers retrospectively studied outcomes associated with this strategy using data from 43 free-standing children's hospitals in the Pediatric Health Information System database.

Between 2005 and 2011, nearly 150,000 children (age range, 6 months – 18 years) were hospitalized with CAP; of these, 15,564 children were included in the study after excluding children with complicated pneumonia, possible healthcare-associated pneumonia, and complex chronic conditions. Ninety percent of study children received broad-spectrum antibiotics and 10% received narrow-spectrum antibiotics. No significant differences were found between the two groups in median length of stay (3 days), transfer to the intensive care unit after 2 days of hospitalization (1.1% and 0.8%), readmissions within 14 days (2.3% and 2.4%), and median cost of hospitalization. Matched analysis of propensity scores in 1044 children in each exposure group also showed no difference between groups. Subgroup analysis of 4876 children with acute wheezing and pneumonia found no differences in outcomes between antibiotic groups or between wheezing and nonwheezing groups.

Comment

The results of this carefully done retrospective study suggest that narrow-spectrum antibiotics are just as effective as broad-spectrum antibiotics for otherwise healthy children requiring admission for uncomplicated community-acquired pneumonia. Judicious use of antibiotics in both the outpatient and inpatient arenas is important to prevent the development of resistant bacterial pathogens.

  • Disclosures for Louis M. Bell, MD at time of publication Grant / research support Institutional Clinical and Translational Science Award; National Center for Pediatric Practice Based Research Learning Editorial boards Current Problems in Pediatric Adolescent Healthcare Leadership positions in professional societies Academic Pediatric Association (Chair, Academic General Pediatrics Fellowship Accreditation Committee)

Citation(s):

Reader Comments (3)

Anita Banerjee Medical Student, School of Tropical Medicine, Kolkata

Great effort to limit the overuse of canon.Hope such effort will continue in South East Asian countries too to lessen the collataeral damage.

Barbara Stewart, MD, FAAP, FACCP Other

Hard to make a good comparison.... would need to be a prospective, not retrospective study. Please consider doing this next... Great start though! Just shows that there is so much more that we don't know, and so much that needs to be done!

J Oh

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