Efficacy and safety of a decision rule for using antibiotics in children with pneumonia and vaccinated against pneumococcus. A randomized controlled trial
Fernando Ferrero1, Fernando Adrián Torres2, Paula Domínguez3
1Departamento de Medicina, Hospital General de Niños Pedro de Elizalde.
Insights
The Bacterial Pneumonia Score (BPS) effectively reduced antibiotic use in vaccinated children with pneumonia. This clinical decision rule identified children needing antibiotics without worsening their outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Decision Making
Background:
- Most childhood pneumonia cases are viral, yet antibiotics are often prescribed.
- The Bacterial Pneumonia Score (BPS) aids antibiotic decisions but needs evaluation in pneumococcal-vaccinated children.
Purpose of the Study:
- To assess if the BPS can decrease antibiotic use in vaccinated children with community-acquired pneumonia compared to standard care.
Main Methods:
- A randomized controlled trial compared BPS-guided antibiotic use versus physician discretion in 65 vaccinated children (3-60 months) with pneumonia.
- Antibiotic administration was based on BPS score >4 in the intervention group.
Main Results:
- Antibiotic use was significantly lower in the BPS group (9/33) versus the control group (21/32).
- No significant difference in unfavorable clinical course between the groups was observed.
Conclusions:
- The BPS is effective in reducing antibiotic prescribing for pneumococcal-vaccinated children with pneumonia.
- Implementing the BPS does not increase the risk of adverse outcomes in this population.
Introduction:
Although most cases of pneumonia in children younger than 5 years old have a viral nature, in everyday practice, they are frequently treated with antibiotics. A clinical decision rule (BPS:Bacterial Pneumonia Score) proved to be effective for identifying which children with pneumonia required antibiotics, but its performance has not been assessed in the population vaccinated against pneumococcal disease. Our objective was to assess whether using the BPS would allow to reduce antibiotic use compared to routine management of children with community acquired pneumonia vaccinated against pneumococcal disease.
Material And Methods:
Randomized, controlled, partially-blinded clinical trial with parallel groups comparing two approaches in the management of children aged 3-60 months old in an outpatient setting because of pneumonia, who had been vaccinated with the pneumococcal conjugate vaccine.The BPS group received antibiotics with a BPS >4 points; while the control group was administered antibiotics at the discretion of the treating physician. The estimated sample size was calculated as, at least, 30 patients per group. The rate of antibiotic use and the clinical course were compared in both groups.
Results:
Sixty-five patients (33 in the BPS group and 32 in the control group) were included; their average age was 17.5 months old. Antibiotic use was significantly higher in the control group than in the BPS group (21/32 versus 9/33; OR: 5.09; 95% CI: 1.57-16.85; p= 0.001). Seven patients had an unfavorable course (three in the BPS group, and four in the control group).
Conclusion:
The use of the BPS allowed to reduce antibiotic use in the initial management of patients with pneumonia vaccinated against pneumococcal disease, without increasing the probability of an unfavorable course of the disease.
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