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

Abstract

BACKGROUND: The 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America community-acquired pneumonia (CAP) guideline recommends narrow-spectrum antimicrobial therapy for most children hospitalized with CAP. However, few studies have assessed the effectiveness of this strategy. METHODS: Using data from 43 children’s hospitals, we conducted a retrospective cohort study to compare outcomes and resource utilization among children hospitalized with CAP between 2005 and 2011 receiving either parenteral ampicillin/penicillin (narrow spectrum) or ceftriaxone/cefotaxime (broad spectrum). Children with complex chronic conditions, interhospital transfers, recent hospitalization, or the occurrence of any of the following during the first 2 calendar days of hospitalization were excluded: pleural drainage procedure, admission to intensive care, mechanical ventilation, death, or hospital discharge. RESULTS: Overall, 13 954 children received broad-spectrum therapy (89.7%) and 1610 received narrow-spectrum therapy (10.3%). The median length of stay was 3 days (interquartile range 3–4) in the broad- and narrow-spectrum therapy groups (adjusted difference 0.12 days, 95% confidence interval [CI]: –0.02 to 0.26). One hundred fifty-six children (1.1%) receiving broad-spectrum therapy and 13 children (0.8%) receiving narrow-spectrum therapy were admitted to intensive care (adjusted odds ratio 0.85, 95% CI: 0.27 to 2.73). Readmission occurred for 321 children (2.3%) receiving broad-spectrum therapy and 39 children (2.4%) receiving narrow-spectrum therapy (adjusted odds ratio 0.85, 95% CI: 0.45 to 1.63). Median costs for the hospitalization were $3992 and $4375 (adjusted difference –$14.4, 95% CI: –177.1 to 148.3). CONCLUSIONS: Clinical outcomes and costs for children hospitalized with CAP are not different when treatment is with narrow- compared with broad-spectrum therapy.

Pattern of Antibiotic Usage in Children Hospitalized for Common Infectious Diseases

“…2018; 6(1):e34474. 5 cillin/penicillin vs. ceftriaxone/cefotaxime) found no appreciable difference in a length of hospital stay, admission to the intensive care unit or readmission between the two groups, however, the cost of treatment in those receiving broad spectrum antibiotics was higher (17). A qualitative study on the use of antimicrobials in the medical department of a teaching hospital reported needless administration of antibiotics in about 23% of the cases while overprescribing of broad-spectrum antibiotics in situations, where a narrow-spectrum antimicrobial would have been sufficient was identified as the most common prescribing error (23).…”

“…Likewise, ceftriaxone or other broad spectrum cephalosporins have been cited as the most frequently used antibiotics in several other studies (15)(16)(17)(18). Extensive use of the third generation cephalosporins has led to the emergence of extended beta-lactamase-(ESBL) producing 4 Arch Pediatr Infect Dis.…”

Glucocorticoids and Hospital Length of Stay for Children with Anaphylaxis: A Retrospective Study

“…29, 30 We included only potential confounders that were highly likely to be determined concurrently with or before the decision to administer glucocorticoids, to avoid inadvertently including mediators or colliders in the model. Potential confounders included demographic characteristics, such as age, sex, race (white, black, Asian, or other), and insurance status (public, private, or other).…”

A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department

“…No patient-level clinical data exists in the database, but this administrative database has been used previously for comparative effectiveness research. 10,11 …”