Narrow-spectrum antibiotics are effective as empiric therapy for children hospitalized with community-acquired pneumonia (CAP), according to a retrospective cohort study at four children's hospitals.
"Clinicians should feel confident that narrow-spectrum therapy produces similar outcomes for otherwise healthy children hospitalized with uncomplicated community acquired pneumonia," lead author Dr. Mary Ann Queen from University of Missouri School of Medicine in Kansas City told Reuters Health by email.
The 2011 guidelines for treating children with CAP published by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA) recommend empiric use of narrow-spectrum coverage with ampicillin or penicillin G for children hospitalized with uncomplicated CAP, but few studies have compared them with broad-spectrum antibiotics.
To investigate, Dr. Queen and colleagues used 2010 data from the Pediatric Health Information System on 492 patients who were 60 days to 18 years of age with a discharge diagnosis of pneumonia.
The rate of narrow-spectrum use ranged from 18.6% to 88.3% among the 4 hospitals in the study, the researchers report Pediatrics December 9. There was no significant difference between the narrow-spectrum and broad-spectrum groups in duration of oxygen, duration of fever, or readmission rate within seven days of discharge.
The length of stay and the overall cost of treatment, however, were significantly shorter in the narrow-spectrum group (43 hours and $3,933) than in the broad-spectrum group (49 hours and $4,704).
After adjustment for length of stay, there was no difference between the groups in average daily standardized cost or average daily standardized pharmacy cost.
"We were not surprised that there was no statistical difference in length of stay between the two groups," Dr. Queen said. "However, it has been argued by some in the past that the cost of cephalosporins may be less than ampicillin due to a less frequent dosing schedule. Within our four hospitals, we found no difference between the two groups."
"In our study, only 33% of all patients with CAP received the recommended therapy with a narrow-spectrum penicillin or aminopenicillin," the researchers note. "These findings are consistent with previous studies and indicate that physicians and some hospitals have yet to reliably change their practice."
Dr. Queen said that at her institution, an antibiotic stewardship program has "greatly improved compliance" with the new guideline recommendations.
"That only a third of all patients with CAP received the recommended therapy with narrow-spectrum penicillin or aminopenicillin illustrates the challenge of bringing physicians' management of pediatric CAP in line with current recommendations," Dr. Pui-Yong Iroh Tam from the University of Minnesota in Minneapolis told Reuters Health by email.
"This evidence showing that narrow-spectrum antibiotics were not inferior to broad-spectrum antibiotics in all measured outcomes, including clinical outcome and cost, may be the most effective way to reassure physicians that following these guidelines are safe for their patients, said Dr. Tam, who was not involved in the new study.
"If the new CAP guidelines have not yet been implemented at (the hospitals in the study), it's likely that non-academic, non-children's hospitals -- where the vast majority of pediatric CAP admissions occur -- have not received the message either," Dr. Michael J. Smith from University of Louisville School of Medicine in Kentucky told Reuters Health by email.
"Broad-spectrum antibiotics are not required for the management of children with uncomplicated community-acquired pneumonia," Dr. Smith, who was not part of the study, concluded. "Here at Kosair Children's Hospital we switched from ceftriaxone to ampicillin for CAP several years ago without incident. This study confirms our local experience at other centers."
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