Comparative Effectiveness of Beta-lactam Versus Macrolide Monotherapy in Children with Pneumonia Diagnosed in the
Lilliam Ambroggio1, Matthew Test, Joshua P Metlay
1From the *Division of Hospital Medicine, †Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; ‡General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts; §Population Health, Geisinger Health System, Danville, Pennsylvania; ¶Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; and ‖Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
For children with community-acquired pneumonia (CAP), treatment failure rates were similar for both beta-lactam and macrolide monotherapy. This finding applies across different age groups in outpatient settings.
Area of Science:
- Pediatric infectious diseases
- Pharmacology and therapeutics
- Clinical research methodology
Background:
- Community-acquired pneumonia (CAP) is frequently managed in outpatient settings for pediatric patients.
- Comparative effectiveness of different antibiotic classes for CAP in children requires further investigation.
Purpose of the Study:
- To compare the clinical effectiveness of beta-lactam monotherapy versus macrolide monotherapy for treating pediatric CAP in outpatient settings.
- To assess treatment failure rates based on antibiotic class and patient age.
Main Methods:
- A retrospective study of children (1-18 years) diagnosed with CAP between 2008-2010.
- Treatment failure was defined as a change in antibiotic prescription within 14 days.
- Propensity score matching was used to compare outcomes between beta-lactam and macrolide monotherapy groups.
Main Results:
- 1164 children were matched from an initial cohort of 1999.
- Asthma was present in 24% of the matched cohort.
- No statistically significant difference in treatment failure rates was observed between macrolide and beta-lactam monotherapy groups across age groups.
Conclusions:
- Beta-lactam and macrolide monotherapy demonstrate comparable clinical effectiveness for pediatric CAP in outpatient settings.
- Age is not a significant factor in determining treatment failure rates between these two antibiotic classes.
Background:
Most children diagnosed with community-acquired pneumonia (CAP) are treated in the outpatient setting. The objective of this study was to determine the comparative clinical effectiveness of beta-lactam monotherapy and macrolide monotherapy in this population.
Study Design:
Children, 1-18 years old, with a clinical diagnosis of CAP at an outpatient practice affiliated (n = 71) with Geisinger Health System during January 1, 2008 to January 31, 2010 were eligible. The primary exposure was receipt of beta-lactam or macrolide monotherapy. The primary outcome was treatment failure defined as change in antibiotic prescription within 14 days of the initial pneumonia diagnosis. Propensity scores were used to determine the likelihood of receiving macrolide monotherapy. Treatment groups were matched 1:1, based on propensity score, age group and asthma status. Multivariable conditional logistic regression models estimated the association between macrolide monotherapy and treatment failures.
Results:
Of 1999 children with CAP, 1164 were matched. In the matched cohorts, 24% of children had asthma. Patients who received macrolide monotherapy had no statistical difference in treatment failure regardless of age when compared with patients who received beta-lactam monotherapy.
Conclusion:
Our findings suggest that children diagnosed with CAP in the outpatient setting and treated with beta-lactam or macrolide monotherapy have the same likelihood to fail treatment regardless of age.
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