Guideline-Concordant Antibiotic Use in Children With Community-Acquired Pneumonia
James W Antoon1, Hui Nian2, Jessica Todd3
1Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
Insights
Over 40% of children with pneumonia received antibiotic treatment not aligned with guidelines. This highlights a need to improve appropriate antibiotic prescribing in pediatric emergency care.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Antibiotic Stewardship
Background:
- National guidelines exist for appropriate antibiotic therapy in pediatric community-acquired pneumonia.
- Significant variation in antibiotic decision-making is observed in clinical practice.
- This study addresses the need to understand guideline adherence in pediatric pneumonia treatment.
Purpose of the Study:
- To determine the prevalence of guideline-concordant antibiotic use in children with pneumonia.
- To identify factors associated with appropriate antibiotic prescribing in the emergency department (ED).
Main Methods:
- Children under 18 with clinical and radiographic pneumonia were enrolled in 2 US children's hospitals.
- Guideline-concordant antibiotic use was defined by the 2011 Infectious Diseases Society of America pediatric pneumonia guideline.
- Multivariable logistic regression analyzed associations between patient characteristics and antibiotic use.
Main Results:
- 74.2% of 772 children received antibiotics; 57.1% received guideline-concordant treatment.
- Antibiotic use was less likely with interstitial radiographic findings and negative viral testing.
- Guideline-concordant treatment was more likely with chest indrawing and less likely with effusion.
Conclusions:
- A substantial proportion of children with pneumonia receive antibiotic treatment inconsistent with established guidelines.
- There are clear opportunities to enhance appropriate antibiotic use in pediatric pneumonia management.
- Improving adherence to guidelines can optimize patient outcomes and combat antibiotic resistance.
Background:
Despite national guidelines on appropriate antibiotic therapy, there is wide variation in antibiotic decision-making for children with community-acquired pneumonia. This study sought to determine prevalence and factors associated with guideline-concordant antibiotic use in children presenting with pneumonia to the emergency department (ED).
Methods:
We enrolled children aged younger than 18 years presenting to the ED at 2 US children's hospitals between September 2017 and May 2019 with clinical and radiographic pneumonia. The primary outcome was guideline-concordant antibiotic use as defined by the 2011 Infectious Diseases Society of America pediatric pneumonia guideline and local expert consensus. Outcomes included proportion of antibiotic use and proportion of guideline-concordant treatment. We used multivariable logistic regression models to determine associations of comorbidities and functional limitations, clinical findings, and radiographic characteristics with overall antibiotic use and guideline-concordant treatment.
Results:
Among 772 included children, 573 received antibiotics (74.2%), and 441 (57.1%) received guideline-concordant antibiotic treatment. Antibiotic initiation was less likely in those with interstitial findings on chest radiograph (adjusted odds ratio [aOR], 0.14; 95% CI, 0.07-0.25) and negative results or nonperformance of viral testing (aOR, 0.39; 95% CI, 0.24-0.65). Guideline-concordant treatment was more likely in those with chest indrawing (aOR, 2.22; 95% CI, 1.34-3.66) and less likely in those with clinically significant effusion (aOR, 0.21; 95% CI, 0.06-0.76).
Conclusions:
Among children presenting to the ED with pneumonia, more than 40% received treatment inconsistent with guideline recommendations. These observations underscore opportunities to improve appropriate antibiotic use in this population.
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