Children Hospitalized With Pneumonia Who Complete Oral Antibiotic Treatment Without Complications
Jillian M Cotter1, Angela Dunn2,3, Derek J Williams4
1Section of Hospital Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, Colorado.
Insights
Most children hospitalized with community-acquired pneumonia (CAP) can be successfully treated with initial oral antibiotics. Treatment decisions may depend more on hospital factors than patient-specific needs.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Pharmacology
- Health Services Research
Background:
- Community-acquired pneumonia (CAP) is a common reason for pediatric hospitalization.
- Intravenous (IV) antibiotic therapy is frequently used, despite evidence suggesting oral antibiotics may be equally effective for many children.
- Understanding factors influencing successful oral antibiotic use in hospitalized children with CAP is crucial for optimizing treatment.
Purpose of the Study:
- To evaluate factors associated with successful outcomes for children hospitalized with CAP who are initially treated with oral antibiotics.
- To identify patient-level and hospital-level predictors of successful oral antibiotic therapy in pediatric CAP.
Main Methods:
- Multicenter retrospective cohort study involving children hospitalized with CAP.
- Data collected from four children's hospitals between 2014 and 2020.
- Multivariable logistic regression used to analyze factors associated with successful oral antibiotic treatment, defined by lack of IV escalation, readmission, or ED revisits within 7 days of discharge.
Main Results:
- 76% of children (n=317) receiving initial oral antibiotics for CAP did well, remaining on oral therapy without escalation or revisits.
- Among those who did not do well (n=102), 80% switched to IV antibiotics but experienced no escalation of care or revisits.
- No patient-level factors were significantly associated with successful oral antibiotic use; only hospital site emerged as a significant factor.
Conclusions:
- The majority of hospitalized children with CAP treated initially with oral antibiotics achieve good outcomes.
- The decision to switch from oral to IV antibiotics may be influenced by non-patient-specific factors, such as clinician preference.
- Further prospective studies are warranted to confirm these findings and guide optimal antibiotic selection in pediatric CAP.
Objective:
While initial oral antibiotics are likely as effective as intravenous (IV) antibiotics for most children hospitalized with community-acquired pneumonia (CAP), most still receive IV therapy. We evaluated factors associated with doing well with initial oral antibiotics among children hospitalized with CAP.
Methods:
We performed a multicenter retrospective cohort study of children hospitalized with CAP who were started on oral antibiotics at 4 children's hospitals between 2014 and 2020. We performed multivariable logistic regression to evaluate the association between hospital site and patient-level factors and doing well with oral antibiotics, defined as those who remained on oral antibiotics throughout the hospitalization, did not have escalation of care during the hospitalization, and did not have readmissions or emergency department revisits within 7 days of discharge.
Results:
Among 419 children who received initial oral antibiotics, 76% (n = 317) did well with this regimen (ie, remained on orals and did not have escalation or revisits). Of those who did not do well (n = 102), 80% (n = 82) switched to IV antibiotics but had no escalation of care or revisits. In multivariable analyses, there were no patient-level factors associated with doing well with initial oral antibiotics, and only hospital site was statistically significant.
Conclusions:
Most children hospitalized with CAP given initial oral antibiotics continued oral therapy and did not have escalation of care or return visits. Switching from oral to IV antibiotics may be based more on nonpatient level factors (eg, clinician preference) than patient-level factors, although prospective studies are needed.
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....
01:14Atypical Pneumonia
01:30Pneumonia III: Complications and Assessment
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:29Pneumonia I: Introduction