Effectiveness of antimicrobial guidelines for community-acquired pneumonia in children
Michael J Smith1, Maiying Kong, Alex Cambon
1Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA. mjsmit22@louisville.edu
Insights
Guidelines and education significantly improved antimicrobial prescribing for pediatric community-acquired pneumonia. This approach offers an effective strategy for antimicrobial stewardship programs.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Public Health Policy
Background:
- Community-acquired pneumonia (CAP) is a common pediatric illness.
- Empirical antibiotic therapy for CAP requires careful consideration of resistance patterns and guideline adherence.
- Antimicrobial stewardship programs aim to optimize antibiotic use and combat resistance.
Purpose of the Study:
- To evaluate the impact of newly developed guidelines and educational interventions on empirical antibiotic selection for pediatric CAP.
- To assess changes in the use of ampicillin versus ceftriaxone following guideline implementation.
- To analyze trends in overall antimicrobial use, length of stay, mortality, and readmission rates.
Main Methods:
- A retrospective review of administrative data for 1,246 children diagnosed with pneumonia between January 2007 and September 2009.
- Antimicrobial prescribing patterns were analyzed across three distinct periods: pre-intervention, post-task force formation, and post-guideline release.
- Quasi-binomial logistic regression models were employed to assess immediate changes and trends in antimicrobial use, accounting for seasonality and autocorrelation.
Main Results:
- Following guideline release, ampicillin use increased from 2% to 44%, while ceftriaxone use decreased from 56% to 28%.
- An immediate and sustained shift in prescribing practices was observed within one month of guideline publication.
- No significant changes were noted in secondary outcomes such as length of stay, mortality, or readmission rates during the study period.
Conclusions:
- Published guidelines coupled with educational initiatives can effectively modify antimicrobial prescribing behavior in pediatric CAP management.
- This study demonstrates a low-cost, low-risk strategy for enhancing antimicrobial stewardship in pediatric settings.
- Further research is needed to determine optimal strategies for pediatric antimicrobial stewardship programs.
Objective:
To assess the effectiveness of guidelines and education on empirical therapy for community-acquired pneumonia.
Methods:
Administrative records for children with a primary diagnosis of pneumonia from January 2007 to September 2009 were reviewed. Antimicrobial use was measured monthly over 3 periods: (1) before creation of an antimicrobial stewardship task force (ASTF), (2) after ASTF formation but before release of guidelines for antimicrobial use, and (3) after guideline release. Antimicrobial use over time was assessed by using quasi-binomial logistic regression models that incorporated interrupted events, seasonality, and autocorrelation. Allowing calculation of immediate changes due to specific interventions and trends in use over each time period. The primary outcome was use of ampicillin as recommended in the guidelines versus ceftriaxone, the historical standard. Secondary outcomes included other antimicrobial use, length of stay, mortality, and readmission.
Results:
One thousand two hundred forty-six children met study criteria. Ampicillin use increased from 2% at baseline to 6% after ASTF formation and 44% after guideline release. Ceftriaxone use increased slightly (from 56% to 59%) after ASTF formation but decreased to 28% after guideline release. An immediate change in prescription occurred in the month after guideline publication and remained stable over the following year.
Conclusions:
Guidelines and education can have an impact on antimicrobial use in the pediatric setting. Although the optimal strategies for pediatric antimicrobial stewardship programs still are being determined, we believe that our approach offers an inexpensive and low-risk step in the right direction.
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