Impact assessment of a decision rule for using antibiotics in pneumonia: a randomized trial
Fernando A Torres1, Irma Pasarelli, Adrián Cutri
1Departamento de Consultorios Externos, Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina.
Insights
The bacterial pneumonia score (BPS) significantly reduced antibiotic use in children with pneumonia. This approach did not increase the risk of treatment failure, offering a safer management strategy.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Medicine
Background:
- Most childhood pneumonia cases are viral, yet antibiotics are frequently prescribed.
- The bacterial pneumonia score (BPS) aids in identifying children who don't need antibiotics.
- The clinical impact of using BPS for pneumonia management in children was previously unevaluated.
Purpose of the Study:
- To evaluate if using the bacterial pneumonia score (BPS) for initial management of childhood pneumonia reduces antibiotic prescriptions.
- To determine if BPS-guided management increases patient risks compared to standard care.
Main Methods:
- A randomized, parallel-group, observer-blind, controlled trial was conducted.
- Children aged 3-60 months with pneumonia were assigned to BPS-guided management (BPS ≥ 4) or routine management.
- Antibiotic use proportions and clinical outcomes were compared between groups.
Main Results:
- Antibiotic use was significantly lower in the BPS group (46.6%) compared to the routine management group (86.6%).
- No significant difference in unfavorable outcomes was observed between the BPS group and the control group (8.3% overall).
Conclusions:
- Management guided by the bacterial pneumonia score (BPS) significantly decreases antibiotic use in children with pneumonia.
- BPS-guided management is effective and does not elevate the rate of treatment failure.
Background:
Although more than half of the cases of pneumonia in children can be due to virus, most of them receive antibiotic treatment. A previously published clinical prediction rule bacterial pneumonia score (BPS) allows the identification of children with pneumonia who do not require antibiotics, but its impact has not been evaluated. We assessed whether the use of the BPS for the initial management of patients with pneumonia results in decreasing the use of antibiotics than under standard management of this condition without increasing patients' risks.
Methods:
This was a randomized, parallel-group, observer-blind, controlled clinical trial comparing the use of antibiotics in children aged 3-60 months treated for pneumonia in an outpatient setting, according to two methods of initial management. Patients were assigned randomly to management according to the BPS (antibiotic indication with a BPS ≥ 4 points) or routine management (antibiotic indication based on the institutional guidelines). We calculated the proportion of the use of antibiotics in each group and evaluated each patient's clinical outcome.
Results:
We included 120 patients (60 BPS and 60 controls) with a mean age of 24.2 ± 14.1 months. The use of antibiotics was significantly lower in the BPS group (46.6% vs. 86.6; OR 0.13; 95% CI: 0.05-0.35; P < 0.001). We observed an unfavorable outcome in 10 patients (8.3%), 5 in each group (P = 1.0; OR: 1.0 95% CI: 0.2-3.6).
Conclusion:
The use of antibiotics was significantly lower in the group managed according to the BPS compared to the conventionally treated group, without increasing the rate of treatment failure.
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