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Antibiotic route and outcomes for children hospitalized with pneumonia
Jillian M Cotter1, Mathew Hall2, Mark I Neuman3,4
1Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA.
Insights
Most children with community-acquired pneumonia (CAP) can be treated with oral antibiotics, as initial IV antibiotics showed similar efficacy. While some outcomes slightly differed, most results were comparable, suggesting oral antibiotics are often suitable for pediatric CAP.
Area of Science:
- Pediatric infectious diseases
- Antibiotic stewardship
- Health services research
Background:
- Emerging evidence suggests comparable efficacy between initial oral and intravenous (IV) antibiotics for pediatric community-acquired pneumonia (CAP).
- Further research is needed to confirm these findings and understand hospital-level variations in antibiotic prescribing.
Purpose of the Study:
- To determine the association between hospital-level initial oral antibiotic rates and patient outcomes in pediatric CAP.
- To compare outcomes such as length of stay, intensive care unit (ICU) transfers, and readmissions between hospitals with high versus low rates of initial oral antibiotic use.
Main Methods:
- Retrospective cohort study of 30,207 children hospitalized with CAP across 43 hospitals (2016-2022).
- Hospitals were categorized into high, moderate, or low oral antibiotic utilization groups.
- Regression models analyzed the association between hospital oral antibiotic rates and outcomes including length of stay (LOS), ICU transfers, escalated respiratory care, complicated CAP, cost, readmissions, and emergency department (ED) revisits.
Main Results:
- Initial oral antibiotic use varied widely (1% to 68%) across hospitals, with a median of 16%.
- Comparing high (32%) versus low (10%) oral-utilizing hospitals revealed no significant differences in LOS, ICU transfers, complicated CAP, cost, or ED revisits.
- Higher rates of escalated respiratory care (RR: 2.96) and readmissions (RR: 1.68) were observed in high oral-utilizing hospitals, though these events were rare and their clinical significance is uncertain.
Conclusions:
- Hospital-level rates of initial oral antibiotic use for pediatric CAP vary significantly.
- While rare adverse events like escalated respiratory care and readmissions were slightly higher in high oral-utilizing hospitals, most key outcomes were similar compared to low oral-utilizing hospitals.
- Most children with CAP likely benefit from oral antibiotics, but a subset may require initial IV therapy.
Background:
Emerging evidence suggests that initial oral and intravenous (IV) antibiotics have similar efficacy in pediatric community-acquired pneumonia (CAP), but further data are needed.
Objective:
We determined the association between hospital-level initial oral antibiotic rates and outcomes in pediatric CAP.
Designs, Settings, And Participants:
This retrospective cohort study included children hospitalized with CAP at 43 hospitals in the Pediatric Health Information System (2016-2022). Hospitals were grouped by whether initial antibiotics were given orally in a high, moderate, or low proportion of patients.
Main Outcome And Measures:
Regression models examined associations between high versus low oral-utilizing hospitals and length of stay (LOS, primary outcome), intensive care unit (ICU) transfers, escalated respiratory care, complicated CAP, cost, readmissions, and emergency department (ED) revisits.
Results:
Initial oral antibiotics were used in 16% (interquartile range: 10%-20%) of 30,207 encounters, ranging from 1% to 68% across hospitals. Comparing high versus low oral-utilizing hospitals (oral rate: 32% [27%-47%] and 10% [9%-11%], respectively), there were no differences in LOS, intensive care unit, complicated CAP, cost, or ED revisits. Escalated respiratory care occurred in 1.3% and 0.5% of high and low oral-utilizing hospitals, respectively (relative ratio [RR]: 2.96 [1.12, 7.81]), and readmissions occurred in 1.5% and 0.8% (RR: 1.68 [1.31, 2.17]). Initial oral antibiotics varied across hospitals without a difference in LOS. While high oral-utilizing hospitals had higher escalated respiratory care and readmission rates, these were rare, the clinical significance of these small differences is uncertain, and there were no differences in other clinically relevant outcomes. This suggests some children may benefit from initial IV antibiotics, but most would probably do well with oral antibiotics.
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