Beta-lactam versus beta- lactam/macrolide therapy in pediatric outpatient pneumonia
Lilliam Ambroggio1,2,3, Matthew Test1, Joshua P Metlay4
1Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
For children aged 6-18 with community-acquired pneumonia (CAP), combination antibiotic therapy using beta-lactam and macrolide was more effective than monotherapy. This approach reduced treatment failure rates in outpatient settings.
Area of Science:
- Pediatric infectious diseases
- Pharmacology and therapeutics
- Clinical research methodology
Background:
- Community-acquired pneumonia (CAP) is a common pediatric illness requiring effective outpatient management.
- Antibiotic selection for CAP impacts treatment outcomes and potential for antibiotic resistance.
- Beta-lactam monotherapy is a standard treatment, but combination therapy is also utilized.
Purpose of the Study:
- To compare the effectiveness of beta-lactam monotherapy versus beta-lactam/macrolide combination therapy for children with CAP.
- To identify differences in treatment failure rates between the two therapeutic approaches in an outpatient setting.
Main Methods:
- Retrospective cohort study of children (1-18 years) diagnosed with CAP between 2008-2010.
- Primary exposure: beta-lactam monotherapy or beta-lactam/macrolide combination therapy.
- Primary outcome: Treatment failure, defined as antibiotic change within 14 days.
- Analysis used logistic regression within a propensity score-restricted cohort.
Main Results:
- 717 children were included; 79.4% received monotherapy, 20.1% received combination therapy.
- Overall treatment failure was 7.7% (8.1% monotherapy vs. 6.1% combination).
- In children aged 6-18 years, combination therapy (4.0% failure) showed lower failure rates than monotherapy (12.9% failure).
- Combination therapy in 6-18 year olds was associated with significantly lower odds of treatment failure (aOR 0.51).
Conclusions:
- Beta-lactam/macrolide combination therapy is more effective than beta-lactam monotherapy for outpatient CAP management in children aged 6-18 years.
- This combination therapy reduces the likelihood of treatment failure in this specific age group.
- Findings support considering combination therapy for older children with CAP.
Objective:
The objective was to evaluate the comparative effectiveness of beta-lactam monotherapy and beta- lactam/macrolide combination therapy in the outpatient management of children with community-acquired pneumonia (CAP).
Methods:
This retrospective cohort study included children, ages 1-18 years, with CAP diagnosed between January 1, 2008 and January 31, 2010 during outpatient management in the Geisinger Health System. The primary exposure was receipt of beta-lactam monotherapy or beta-lactam/macrolide combination therapy. The primary outcome was treatment failure, defined as a follow-up visit within 14 days of diagnosis resulting in a change in antibiotic therapy. Logistic regression within a propensity score- restricted cohort was used to estimate the likelihood of treatment failure.
Results:
Of 717 children in the analytical cohort, 570 (79.4%) received beta-lactam monotherapy and 147 (20.1%) received combination therapy. Of those who received combination therapy 58.2% of children were under 6 years of age. Treatment failure occurred in 55 (7.7%) children, including in 8.1% of monotherapy recipients, and 6.1% of combination therapy recipients. Treatment failure rates were highest in children 6-18 years receiving monotherapy (12.9%) and lowest in children 6-18 years receiving combination therapy (4.0%). Children 6-18 years of age who received combination therapy were less likely to fail treatment than those who received beta-lactam monotherapy (propensity-adjusted odds ratio, 0.51; 95% confidence interval, 0.28, 0.95).
Conclusion:
Children 6-18 years of age who received beta- lactam/macrolide combination therapy for CAP in the outpatient setting had lower odds of treatment failure compared with those who received beta-lactam monotherapy.
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