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Published on: February 23, 2014
Changing clinical practice: management of paediatric community-acquired pneumonia
Mohamed A Elemraid1, Stephen P Rushton, Matthew F Thomas
1Department of Paediatric Infectious Disease and Immunology, Newcastle upon Tyne Hospitals NHS Trust, Newcastle, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
Insights
UK pneumonia guidelines improved paediatric community-acquired pneumonia (PCAP) care. Investigations and intravenous antibiotic use decreased, with a shift towards oral antibiotics, aligning with recommendations and enhancing antimicrobial stewardship.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Practice Guidelines
- Antimicrobial Stewardship
Background:
- Paediatric community-acquired pneumonia (PCAP) management has evolved with guideline development.
- Previous studies highlight variations in diagnostic and treatment approaches for PCAP.
Purpose of the Study:
- To evaluate the impact of UK pneumonia guidelines published in 2002 on PCAP clinical features and management.
- To compare current PCAP management with pre-guideline data from 2001-2002.
Main Methods:
- A prospective survey of 11 hospitals in Northern England conducted in 2008-2009.
- Data collection included clinical and laboratory findings for children (≤16 years) with pneumonia.
- Comparison with a similar survey conducted prior to guideline implementation.
Main Results:
- A significant reduction in investigations, including full blood count, blood cultures, and respiratory pathogen testing, was observed post-guidelines.
- Intravenous antibiotic use decreased from 47% to 36% of total prescriptions.
- A notable shift towards oral antibiotic monotherapy increased from 16% to 50%.
Conclusions:
- Post-guideline changes in PCAP management, excluding routine acute phase reactant measurement, align with recommendations.
- Improvements in antibiotic prescribing practices support antimicrobial stewardship initiatives.
- Adoption of guidelines may offer financial benefits to healthcare services.
Rationale And Aim:
To compare clinical features and management of paediatric community-acquired pneumonia (PCAP) following the publication of UK pneumonia guidelines in 2002 with data from a similar survey at the same hospitals in 2001-2002 (pre-guidelines).
Methods:
A prospective survey of 11 hospitals in Northern England was undertaken during 2008-2009. Clinical and laboratory data were recorded on children aged ≤16 years who presented with clinical and radiological features of pneumonia.
Results:
542 children were included. There was a reduction in all investigations performed (P < 0.001) except C-reactive protein (P = 0.448) between surveys. These included full blood count (76% to 61%); blood culture (70% to 53%) and testing of respiratory secretions for viruses (24% to 12%) and bacteria (18% to 8%). Compared to pre-guidelines, there was a reduction in the use of intravenous antibiotics as a proportion of the total prescribed from 47% to 36% (P < 0.001) and a change in the route of antibiotic administration with increasing preference for oral alone (16% pre-compared to 50% post-guidelines, P < 0.001).
Conclusion:
Apart from the acute phase reactants that should not be measured routinely, these changes are in line with the guideline recommendations. Improvements in antibiotic use are possible and have implications for future antimicrobial stewardship programmes. Further work using cost-effectiveness analysis may also demonstrate a financial benefit to health services from adoption of guidelines.
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