Short- Versus Prolonged-Duration Antibiotics for Outpatient Pneumonia in Children
Daniel J Shapiro1, Matthew Hall2, Susan C Lipsett3
1Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
Insights
Most children with community-acquired pneumonia (CAP) receive 10-day antibiotic prescriptions. Short-duration antibiotics showed no significant difference in adverse outcomes compared to longer courses for pediatric CAP patients.
Area of Science:
- Pediatric infectious diseases
- Clinical pharmacology
- Health services research
Background:
- Community-acquired pneumonia (CAP) is a common pediatric illness.
- Antibiotic prescribing duration for pediatric CAP varies in clinical practice.
- Understanding practice patterns and outcomes is crucial for optimizing treatment.
Purpose of the Study:
- To analyze antibiotic prescription durations for ambulatory pediatric CAP.
- To compare adverse clinical outcomes between short- and prolonged-duration antibiotic courses.
- To inform evidence-based guidelines for pediatric CAP management.
Main Methods:
- Retrospective cohort study using a large US Medicaid claims database (2010-2016).
- Included 121,846 outpatient pediatric CAP encounters with oral antibiotic prescriptions.
- Used logistic regression to compare outcomes (hospitalization, new prescriptions, acute care visits) for 5-9 day vs. 10-14 day antibiotic durations.
Main Results:
- The majority of children (82.8%) received 10-day antibiotic courses; 10.5% received short-duration therapy (5-9 days).
- Adverse outcomes were infrequent: 0.2% hospitalization, 6.2% new antibiotic prescriptions, 5.1% acute care visits.
- Short-duration therapy was not associated with significantly higher rates of hospitalization (aOR 1.16), new prescriptions (aOR 0.93), or acute care visits (aOR 1.06) compared to prolonged durations.
Conclusions:
- Current practice predominantly favors 10-day antibiotic courses for pediatric outpatient CAP.
- No significant differences in adverse clinical outcomes were observed between short- and prolonged-duration antibiotic regimens.
- Findings suggest that shorter antibiotic durations may be a safe alternative for select pediatric CAP cases.
Objective:
To identify practice patterns in the duration of prescribed antibiotics for the treatment of ambulatory children with community-acquired pneumonia (CAP) and to compare the frequency of adverse clinical outcomes between children prescribed short-vs prolonged-duration antibiotics.
Study Design:
We performed a retrospective cohort study from 2010-2016 using the IBM Watson MarketScan Medicaid Database, a claims database of publicly insured patients from 11 states. We included children 1-18 years old with outpatient CAP who filled a prescription for oral antibiotics (n = 121 846 encounters). We used multivariable logistic regression to determine associations between the duration of prescribed antibiotics (5-9 days vs 10-14 days) and subsequent hospitalizations, new antibiotic prescriptions, and acute care visits. Outcomes were measured during the 14 days following the end of the dispensed antibiotic course.
Results:
The most commonly prescribed duration of antibiotics was 10 days (82.8% of prescriptions), and 10.5% of patients received short-duration therapy. During the follow-up period, 0.2% of patients were hospitalized, 6.2% filled a new antibiotic prescription, and 5.1% had an acute care visit. Compared with the prolonged-duration group, the aORs for hospitalization, new antibiotic prescriptions, and acute care visits in the short-duration group were 1.16 (95% CI 0.80-1.66), 0.93 (95% CI 0.85-1.01), and 1.06 (95% CI 0.98-1.15), respectively.
Conclusions:
Most children treated for CAP as outpatients are prescribed at least 10 days of antibiotic therapy. Among pediatric outpatients with CAP, no significant differences were found in rates of adverse clinical outcomes between patients prescribed short-vs prolonged-duration antibiotics.
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