Antibiotic use and outcomes among children hospitalized with suspected pneumonia
Jillian M Cotter1, Todd A Florin2, Angela Moss3
1Section of Hospital Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA.
Insights
Antibiotics for childhood community-acquired pneumonia (CAP) did not affect hospital stay or readmissions. However, antibiotic use in children with CAP was linked to a shorter duration of fever after discharge.
Area of Science:
- Pediatric infectious diseases
- Clinical pharmacology
- Epidemiology
Background:
- Viral infections are the primary cause of community-acquired pneumonia (CAP).
- Antibiotic prescription for CAP is common despite frequent viral etiologies.
- Understanding the impact of antibiotics on pediatric CAP outcomes is crucial.
Purpose of the Study:
- To assess the association between early antibiotic administration and clinical outcomes in hospitalized children with suspected CAP.
- To investigate the effect of emergency department (ED) antibiotic exposure on length of stay, care escalation, treatment failure, and quality of life.
Main Methods:
- Secondary analysis of a prospective cohort of children hospitalized with suspected CAP.
- Exposure defined as antibiotic receipt in the ED.
- Inverse probability treatment weighting and propensity analyses used to control for confounding by indication.
Main Results:
- No significant differences in length of stay, escalated care, treatment failure, or 30-day ED revisits were observed between children who received antibiotics and those who did not.
- Children receiving antibiotics experienced a 37% decrease in the mean number of days with fever post-discharge.
- No significant differences in other quality-of-life measures were found.
Conclusions:
- Early antibiotic use in suspected pediatric CAP does not appear to negatively impact key clinical outcomes like hospital stay or readmissions.
- Antibiotic administration may be associated with a reduction in post-discharge fever duration.
- Further research may clarify the role of antibiotics in managing pediatric CAP, particularly regarding symptom duration.
Background:
Although viral etiologies predominate, antibiotics are frequently prescribed for community-acquired pneumonia (CAP).
Objective:
We evaluated the association between antibiotic use and outcomes among children hospitalized with suspected CAP.
Designs, Settings And Participants:
We performed a secondary analysis of a prospective cohort of children hospitalized with suspected CAP.
Intervention:
The exposure was the receipt of antibiotics in the emergency department (ED).
Main Outcome And Measures:
Clinical outcomes included length of stay (LOS), care escalation, postdischarge treatment failure, 30-day ED revisit, and quality-of-life (QoL) measures from a follow-up survey 7-15 days post discharge. To minimize confounding by indication (e.g., radiographic CAP), we performed inverse probability treatment weighting with propensity analyses.
Results:
Among 523 children, 66% were <5 years, 88% were febrile, 55% had radiographic CAP, and 55% received ED antibiotics. The median LOS was 41 h (IQR: 25, 54). After propensity analyses, there were no differences in LOS, escalated care, treatment failure, or revisits between children who received antibiotics and those who did not. Seventy-one percent of patients completed follow-up surveys after discharge. Among 16% of patients with fevers after discharge, the median fever duration was 2 days, and those who received antibiotics had a 37% decrease in the mean number of days with fever (95% confidence interval: 20% and 51%). We found no statistical differences in other QoL measures.
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