Impact of a Guideline on Management of Children Hospitalized With Community-Acquired Pneumonia

Newman, Ross; Hedican, Erin B.; Herigon, Joshua C.; Williams, David D.; Williams, Arthur R.; Newland, Jason G.

doi:10.1542/peds.2011-1533

Cited by 110 publications

(88 citation statements)

References 43 publications

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“…13 Experiences at individual hospitals have been similar. 12,28 Multilevel interventions may be most effective for influencing physician prescribing behavior. 29,30 Ambroggio et al demonstrated that the development of a hospital-based practice guideline, accompanied with an educational campaign and modification of an existing CAP order set, increased guideline-concordant antibiotic prescribing for children hospitalized with CAP from 30% to 100% within 6 months.…”

Section: Discussionmentioning

confidence: 99%

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Antibiotic Choice for Children Hospitalized With Pneumonia and Adherence to National Guidelines

Williams

Edwards

Self³

et al. 2015

Pediatrics

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INTRODUCTION: The 2011 national guidelines for the management of childhood community-acquired pneumonia (CAP) recommended narrow-spectrum antibiotics (eg, ampicillin) for most children hospitalized with CAP. We assessed the impact of these guidelines on antibiotic prescribing at 3 children’s hospitals. METHODS: Children hospitalized with clinical and radiographic CAP were enrolled from January 1, 2010, through June 30, 2012, at 3 hospitals in Tennessee and Utah as part of the Centers for Disease Control and Prevention Etiology of Pneumonia in the Community study. Antibiotic selection was determined by the treating provider. The impact of the guidelines and hospital-level implementation efforts was determined by assessing the monthly percentage of enrolled children receiving third-generation cephalosporins or penicillin/ampicillin. Segmented linear regression was used to compare observed antibiotic selection in the postguideline period with expected antibiotic use projected from preguideline months. RESULTS: Overall, 2121 children were included. During the preguideline period, 52.8% (interquartile range 47.8–56.6) of children with CAP received third-generation cephalosporins, whereas 2.7% (2.1, 7.0) received penicillin/ampicillin. By 9 months postguidelines, third-generation cephalosporin use declined (absolute difference −12.4% [95% confidence interval −19.8% to −5.1%]), whereas penicillin/ampicillin use increased (absolute difference 11.3% [4.3%–18.3%]). The most substantial changes were noted at those institutions that implemented guideline-related dissemination activities. CONCLUSIONS: After publication of national guidelines, third-generation cephalosporin use declined and penicillin/ampicillin use increased among children hospitalized with CAP. Changes were more apparent among those institutions that proactively disseminated the guidelines, suggesting that targeted, hospital-based efforts are important for timely implementation of guideline recommendations.

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Section: Discussionmentioning

confidence: 99%

“…Because hospital-level efforts have been shown to be important for guideline implementation and altering prescribing practices, [12][13][14][15][16] we also explored the impact of guidelinerelated, individual hospital-based initiatives.…”

Section: What This Study Addsmentioning

confidence: 99%

Antibiotic Choice for Children Hospitalized With Pneumonia and Adherence to National Guidelines

Williams

Edwards

Self³

et al. 2015

Pediatrics

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“…Although some studies suggest that penicillins are as effective as broad-spectrum antibiotics for empiric treatment of CAP due to S pneumoniae, few studies have directly compared the 2 regimens. 4,[6][7][8] Evidence showing the effectiveness of narrow-spectrum antibiotic therapy has the potential to improve adherence to the national guideline and minimize the development of bacterial resistance. The objective of this study was to compare the effectiveness of empiric therapy with narrowspectrum antibiotics with empiric therapy with broad-spectrum antibiotics in children hospitalized with uncomplicated CAP.…”

mentioning

confidence: 99%

Comparative Effectiveness of Empiric Antibiotics for Community-Acquired Pneumonia

Queen¹,

Myers

Hall

et al. 2014

Pediatrics

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BACKGROUND AND OBJECTIVE: Narrow-spectrum antibiotics are recommended as the first-line agent for children hospitalized with community-acquired pneumonia (CAP). There is little scientific evidence to support that this consensus-based recommendation is as effective as the more commonly used broad-spectrum antibiotics. The objective was to compare the effectiveness of empiric treatment with narrow-spectrum therapy versus broad-spectrum therapy for children hospitalized with uncomplicated CAP. METHODS: This multicenter retrospective cohort study using medical records included children aged 2 months to 18 years at 4 children's hospitals in 2010 with a discharge diagnosis of CAP. Patients receiving either narrow-spectrum or broad-spectrum therapy in the first 2 days of hospitalization were eligible. Patients were matched by using propensity scores that determined each patient’s likelihood of receiving empiric narrow or broad coverage. A multivariate logistic regression analysis evaluated the relationship between antibiotic and hospital length of stay (LOS), 7-day readmission, standardized daily costs, duration of fever, and duration of supplemental oxygen. RESULTS: Among 492 patients, 52% were empirically treated with a narrow-spectrum agent and 48% with a broad-spectrum agent. In the adjusted analysis, the narrow-spectrum group had a 10-hour shorter LOS (P = .04). There was no significant difference in duration of oxygen, duration of fever, or readmission. When modeled for LOS, there was no difference in average daily standardized cost (P = .62) or average daily standardized pharmacy cost (P = .26). CONCLUSIONS: Compared with broad-spectrum agents, narrow-spectrum antibiotic coverage is associated with similar outcomes. Our findings support national consensus recommendations for the use of narrow-spectrum antibiotics in children hospitalized with CAP.

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“…21 After the implementation of an antibiotic stewardship program and a local practice guideline in a tertiary US children' s hospital, Newman et al demonstrated a significant increase in use of ampicillin from 15% to 60%, a corresponding decrease in ceftriaxone use, and no significant difference in the rate of treatment failure among .1000 children hospitalized with uncomplicated CAP. 22 That study was conducted in an Data presented as median [IQR] or n (%). Models adjusted for age, gender, race/ethnicity, payer, asthma comorbidity, previous hospitalization, month and year, resource utilization (oxygen therapy, blood products, chest ultrasound and computed tomography, blood gas analysis), and concomitant medication use (macrolides, bronchodilators, corticosteroids, oseltamivir).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have demonstrated the feasibility and effectiveness of stewardship programs and dissemination of local practice guidelines on changing antimicrobial selection for CAP management. 22,[30][31][32][33] The publication of the first consensus guidelines for childhood CAP management could serve as a catalyst for these initiatives.…”

Section: Discussionmentioning

confidence: 99%

Narrow Vs Broad-spectrum Antimicrobial Therapy for Children Hospitalized With Pneumonia

2013

PEDIATRICS

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Impact of a Guideline on Management of Children Hospitalized With Community-Acquired Pneumonia

Cited by 110 publications

References 43 publications

Antibiotic Choice for Children Hospitalized With Pneumonia and Adherence to National Guidelines

Antibiotic Choice for Children Hospitalized With Pneumonia and Adherence to National Guidelines

Comparative Effectiveness of Empiric Antibiotics for Community-Acquired Pneumonia

Narrow Vs Broad-spectrum Antimicrobial Therapy for Children Hospitalized With Pneumonia

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