The Influence of National Guidelines on the Management of Community-Acquired Pneumonia in Children. Do Pediatricians Follow the Recommendations?

Kraj, Grażyna; Peradzyńska, Joanna; Chądzyńska, Julita; Kulus, Marek; Wołoszyn, Krystian; Jackowska, Teresa; Krajewska, Maria; Mołdoch-Łukasik, Anna; Czubik-Przybyła, Agnieszka; Górska–Kot, Aneta; Krenke, Katarzyna

doi:10.1007/5584_2019_392

Cited by 7 publications

(4 citation statements)

References 17 publications

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“…Adherence to clinical guidance was low and there were no previous studies on the management of ambulatory CAP in Latin America with which to compare our findings. However, our results are similar to a study in hospitalized CAP cases in Poland ( 28 ). Poor adherence to similar guidelines has been reported in Brazil (26% adherence), while higher adherence has been reported in Pakistan and Lebanon(> 50%) ( 29 – 31 ).…”

Section: Discussionsupporting

confidence: 91%

Adherence to guidelines on the use of amoxicillin for treatment of ambulatory pneumonia in children younger than 5 years, Colombia, 2017–2019

Ariza

Ochoa

Shewade

et al. 2023

Revista Panamericana De Salud Pública

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Objectives. To determine the level of adherence to clinical guidelines in prescribing amoxicillin to children younger than 5 years with pneumonia in outpatient settings in Colombia from 2017 to 2019, and assess the factors associated with adherence Methods. This was a cross-sectional study of secondary data from the Colombian Integrated Social Protection Information System database. Adherence was defined as prescription of oral amoxicillin for bacterial and unspecified pneumonia and non-prescription for viral pneumonia. Variables examined included: age (< 1 year, 1–4 years) of child; sex; cause of pneumonia (bacterial, viral, unspecified); region (Andean, Amazonian, Pacific, Caribbean, Insular, Orinoquian); and payment mechanism (without prior authorization, capitation, direct payment, pay per case, pay for event). Results. Of 215 925 cases of community-acquired pneumonia reported during 2017–2019, 64.8% were from the Andean region, 73.9% were bacterial pneumonia and 1.8% were viral pneumonia. Adherence to guidelines was observed in 5.8% of cases: this was highest for children diagnosed with viral (86.0%) compared with bacterial (2.0%) pneumonia. For children diagnosed with bacterial pneumonia, 9.4% were prescribed any antibiotic. A greater proportion of children covered by capitated payments (22.3%) were given treatment consistent with the guidelines compared with payment for event (1.3%). Conclusion. In this first study from Colombia, adherence to guidelines for outpatient treatment of children with bacterial pneumonia was low and was better for viral pneumonia. Further qualitative studies are needed to explore the reasons for this lack of adherence and why bacterial pneumonia was the most commonly reported etiology.

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Section: Discussionsupporting

confidence: 91%

Adherence to guidelines on the use of amoxicillin for treatment of ambulatory pneumonia in children younger than 5 years, Colombia, 2017–2019

Ariza

Ochoa

Shewade

et al. 2023

Revista Panamericana De Salud Pública

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“…Community-acquired pneumonia (CAP) is a highly prevalent infection and remains the first cause of early childhood mortality in developing countries (1)(2)(3). Scientific guidelines were established to optimize and standardize medical care yet, several authors reported discrepancies between recommendations and actual management (4)(5)(6)(7)(8), leading to overuse of antibiotics, a higher resistance rate in community-acquired pathogens (9), and longer hospitalizations (7). This study aims to evaluate our local inpatient practices in children with CAP and to identify clinical parameters likely to influence adherence to guidelines, in order to better understand eventual gaps in our medical approaches.…”

Section: Introductionmentioning

confidence: 99%

Management of Community-Acquired Pneumonia in Pediatrics: Adherence to Clinical Guidelines

2020

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Objectives: To evaluate adherence to guidelines for inpatient care of pediatric patients with community-acquired pneumonia (CAP). Background: Pediatric CAP is one of the most common acute infections requiring hospital admission. Discrepancies between recommended care and effective management are reported, raising the necessity to evaluate our local clinical practices. Patients and Methods: Retrospective data review of all children hospitalized for CAP at our institution was conducted between 2014 and 2017. Adherence to inpatient care guidelines was evaluated with a focus on indication of hospitalization, initial antibiotic choice, treatment duration, and hospital stay. A bivariate analysis was performed to identify clinical factors influencing adherence rates. Results: A total of 122 children (median age of 3.5 years) were identified. Hospital admission was indicated in 47.5% of patients and was driven by the value of serum CRP as well as prolonged fever. Median hospital stay was 4 days and was justified in 23.8% of patients. The choice of antibiotics was relevant in 91.8% of cases and amoxicillin-clavulanate was the most prescribed drug. The drugs dose, interval, and route of administration were respected in all cases. Antimicrobial therapy lasted for a median of 10 days and was in accordance with recommendations in 58.3% of patients. No clinical parameter was found to be significantly associated with length of stay or choice and duration of treatment. Conclusions: The choice of antibiotics was consistent with guidelines but treatment duration, indication and length of hospitalization still need to be improved.

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“…Except for significant fluctuations and shifts in epidemiological trends, local antimicrobial stewardship and infection management guidelines need to be based upon current data; the local Polish data on the contribution of the particular etiological factors in hospitalized CAP cases, however, are scarce. Moreover, antibiotics are overused and often inappropriately prescribed, making CAP a significant public health concern in Poland [ 39 ]. Another rationale behind this study was the fact that, although CAP is one of the most frequent problems, investigations on the practical use of inflammatory markers are still lacking.…”

Section: Introductionmentioning

confidence: 99%

The Etiology of Community-Acquired Pneumonia Correlates with Serum Inflammatory Markers in Children

Wrotek

Robakiewicz²,

Pawlik³

et al. 2022

JCM

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Community-acquired pneumonia (CAP) severely affects pediatric hospitalizations. This study assessed the contribution of CAP to hospitalizations, its etiology in relationship with age, and the inflammatory markers. Between 2013 and 2018, 1064 CAP patients were hospitalized and diagnosed with bacterial/possibly bacterial pneumonia (BP), viral/possibly viral pneumonia (VP) and atypical pneumonia (AP). The etiology was confirmed using blood/pleural fluid culture/polymerase chain reaction (PCR), rapid antigen test/PCR in nasopharyngeal swabs, or serological studies. CAP accounted for 9.9% of hospitalizations and 14.8% of patient days. BP was diagnosed in 825 (77.5%), VP in 190 (17.9%), and AP in 49 (4.6%) cases; the confirmed etiology (n = 209; 20%) included mostly influenza (39%; n = 82), respiratory syncytial virus (RSV, 35%; n = 72), and Mycoplasma pneumoniae (19%; n = 39). VP frequency decreased with age (41% in < 3 mo to 9% in ≥ 60 mo), in contrast to AP (13% in ≥ 60 mo). Among the analyzed parameters, the best differentiating potential was shown by: C-reactive protein (CRP, AUCBP-VP = 0.675; 95% CI: 0.634–0.715), procalcitonin (AUCBP-AP = 0.73; 95% CI: 0.67–0.794), and CRP/procalcitonin (AUCAP-VP = 0.752; 95% CI: 0.67–0.83); a good positive predictive value (88.8%, 98.3%, and 91.6%, respectively) but a low negative predictive value (29.5%, 13.1%, and 40.7%, respectively) was observed. CAP influences hospital patient days more than the crude number of patients would suggest. On a clinical basis, BP is mainly recognized, although viral pneumonia is confirmed most often. RSV and influenza are responsible for a huge percentage of hospitalized cases, as well as M. pneumoniae in children aged ≥ 5 years. Serum inflammatory markers may help differentiate etiological factors.

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The Influence of National Guidelines on the Management of Community-Acquired Pneumonia in Children. Do Pediatricians Follow the Recommendations?

Cited by 7 publications

References 17 publications

Adherence to guidelines on the use of amoxicillin for treatment of ambulatory pneumonia in children younger than 5 years, Colombia, 2017–2019

Adherence to guidelines on the use of amoxicillin for treatment of ambulatory pneumonia in children younger than 5 years, Colombia, 2017–2019

Management of Community-Acquired Pneumonia in Pediatrics: Adherence to Clinical Guidelines

The Etiology of Community-Acquired Pneumonia Correlates with Serum Inflammatory Markers in Children

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