Differences in antibiotic treatment for children hospitalized with pneumonia

Area of Science:

• Pediatric hospital medicine
• Health equity research
• Antibiotic stewardship

Background:

• Prior research identified disparities in pediatric antibiotic use in outpatient settings.
• Limited studies have investigated antibiotic use disparities within the inpatient pediatric setting.

Purpose of the Study:

• To assess the association between race/ethnicity and the Childhood Opportunity Index (COI) with antibiotic utilization in hospitalized children diagnosed with pneumonia.
• To identify potential inequities in antibiotic prescribing patterns based on socioeconomic and demographic factors.

Main Methods:

• A cross-sectional study analyzed data from 49,332 children hospitalized with pneumonia across 43 hospitals.
• Generalized estimating equations were used to evaluate associations between race/ethnicity, COI quintiles, and antibiotic use, adjusting for confounders.
• Antibiotic utilization metrics included overall use, spectrum (broad vs. narrow), and route (intravenous vs. oral).

Main Results:

• Non-Hispanic White children received antibiotics less frequently than Asian and non-Hispanic Black children.
• Hispanic children showed higher odds of receiving broad-spectrum antibiotics compared to non-Hispanic White children.
• Children from the lowest COI quintile had increased odds of receiving antibiotics and broad-spectrum antibiotics compared to those in the highest COI quintile.

Conclusions:

• Pediatric pneumonia patients from certain minoritized racial/ethnic groups and those from neighborhoods with the lowest opportunity demonstrated higher odds of receiving antibiotics.
• These findings indicate significant disparities in antibiotic prescribing for pediatric pneumonia, particularly concerning spectrum and route of administration.
• The study underscores the need for targeted interventions to address inequities in inpatient pediatric antibiotic use.