Parent and Clinician Views on Not Using Antibiotics for Mild Community-Acquired Pneumonia
Julia E Szymczak1, Ashley A Hayes2, Patricia Labellarte2
1Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Insights
Parents and clinicians face challenges implementing a "no antibiotic" strategy for mild community-acquired pneumonia (CAP) in young children. Overcoming these requires addressing emotional, social, and diagnostic factors for better antibiotic stewardship.
Area of Science:
- Pediatric infectious diseases
- Antibiotic stewardship
- Qualitative research methods
Background:
- Mild community-acquired pneumonia (CAP) in preschool-aged children is often viral, yet antibiotics are routinely prescribed.
- This practice contributes to antibiotic resistance and unnecessary healthcare costs.
Purpose of the Study:
- To identify barriers preventing the implementation of a
- no antibiotic
- strategy for mild CAP in young children.
- To understand parental and clinician perspectives on managing mild CAP without antibiotics.
Main Methods:
- A qualitative study utilizing semistructured interviews.
- Inclusion of 18 parents and 20 clinicians at a large US pediatric hospital.
- Interviews conducted between January 2021 and July 2021.
Main Results:
- No parents were aware of the
- no antibiotic
- strategy; parental support varied based on trust, emotional factors, and perceived risks.
- Clinicians faced challenges including diagnostic uncertainty, parental expectations, and concerns about undertreatment.
- Key barriers identified were diagnostic uncertainty, parental expectations, and managing perceived risks.
Conclusions:
- Managing mild CAP without antibiotics presents significant stewardship challenges for both parents and clinicians.
- Future interventions must address emotional, social, and logistical aspects of care.
- Improving diagnostic accuracy is crucial for successful implementation of antibiotic-sparing strategies.
Objectives:
Preschool-aged children with mild community-acquired pneumonia (CAP) routinely receive antibiotics even though most infections are viral. We sought to identify barriers to the implementation of a "no antibiotic" strategy for mild CAP in young children.
Methods:
Qualitative study using semistructured interviews conducted in a large pediatric hospital in the United States from January 2021 to July 2021. Parents of young children diagnosed with mild CAP in the previous 3 years and clinicians practicing in outpatient settings (pediatric emergency department, community emergency department, general pediatrics offices) were included.
Results:
Interviews were conducted with 38 respondents (18 parents, 20 clinicians). No parent heard of the no antibiotic strategy, and parents varied in their support for the approach. Degree of support related to their desire to avoid unnecessary medications, trust in clinicians, the emotional difficulty of caring for a sick child, desire for relief of suffering, willingness to accept the risk of unnecessary antibiotics, and judgment about the child's illness severity. Eleven (55%) clinicians were familiar with guidelines specifying a no antibiotic strategy. They identified challenges in not using antibiotics, including diagnostic uncertainty, consequences of undertreatment, parental expectations, follow-up concerns, and acceptance of the risks of unnecessary antibiotic treatment of many children if it means avoiding adverse outcomes for some children.
Conclusions:
Although both parents and clinicians expressed broad support for the judicious use of antibiotics, pneumonia presents stewardship challenges. Interventions will need to consider the emotional, social, and logistical aspects of managing pneumonia, in addition to developing techniques to improve diagnosis.
More Related Videos
Related Concept Videos
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
01:30Pneumonia III: Complications and Assessment
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:26Tonsillitis II: Management
01:25Transmission-based Precautions II: Airborne and Protective Environment
Airborne precautions:
Use airborne precautions when treating patients known or suspected to have diseases that spread through the air—for example, tuberculosis or measles. These organisms are present in smaller droplets expelled by an infected person and...