Variability in pediatric infectious disease consultants' recommendations for management of community-acquired

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Published on: February 23, 2014

Adam L Hersh1, Daniel J Shapiro, Jason G Newland

  • 1Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah, United States of America. adam.hersh@hsc.utah.edu

Plos One
|June 10, 2011
PubMed

Insights

Pediatric infectious disease specialists show significant variation in managing community-acquired pneumonia (CAP) and parapneumonic empyema (PPE). Guidelines and local resistance data are needed to standardize antibiotic prescribing for pediatric CAP.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Stewardship
  • Clinical Practice Variation

Background:

  • Community-acquired pneumonia (CAP) is a prevalent childhood infection with increasing complications like parapneumonic empyema (PPE).
  • Antibiotic-resistant organisms are a growing concern in pediatric CAP and PPE cases.
  • Current clinical guidelines for pediatric CAP management and data on antibiotic prescribing patterns are lacking.

Purpose of the Study:

  • To assess variations in clinical management of pediatric CAP among infectious disease consultants.
  • To investigate the relationship between prescribed antibiotic regimens and local antibiotic resistance levels.
  • To identify opportunities for improving pediatric CAP and PPE care.

Main Methods:

  • A survey was distributed to 259 pediatric infectious disease physicians in the Emerging Infections Network.
  • Physicians reported on empiric antibiotic regimens and therapy durations for CAP with and without PPE.
  • Physicians also provided data on local prevalence of penicillin-non-susceptible S. pneumoniae and methicillin-resistant S. aureus (MRSA).

Main Results:

  • Respondents were divided on empiric antibiotic choices for uncomplicated CAP (beta-lactams alone vs. combination therapy).
  • For PPE, most recommended beta-lactams plus an anti-MRSA agent, with divided preferences between clindamycin and vancomycin.
  • Prescribing patterns showed mixed associations with resistance, but increased MRSA prevalence correlated with higher likelihood of anti-MRSA agent recommendation.

Conclusions:

  • Significant variability exists in the management of pediatric CAP and PPE.
  • Development of clinical guidelines through antimicrobial stewardship programs is recommended.
  • Disseminating local antibiotic resistance data can help standardize and improve care for pediatric CAP.
Abstract

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