Comparative effectiveness of empiric antibiotics for community-acquired pneumonia

Creator(s)

Mary Ann Queen, Children's Mercy HospitalFollow
Angela Myers, Children's Mercy HospitalFollow
Matthew Hall, Children's Hospital Association
Samir S. Shah, University of Cincinnati College of Medicine
Derek J. Williams, Monroe Carell Jr. Children's Hospital at Vanderbilt
Katherine A. Auger, University of Cincinnati College of Medicine
Karen E. Jerardi, University of Cincinnati College of Medicine
Angela M. Statile, University of Cincinnati College of Medicine
Joel S. Tieder, University of Washington School of Medicine

Document Type

Article

Publication Date

1-2014

Identifier

DOI: 10.1542/peds.2013-1773; PMCID: PMC4535024

Abstract

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 narrowspectrum 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 narrowspectrum 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.

Copyright © 2014 by the American Academy of Pediatrics.

Journal Title

Pediatrics

Volume

133

Issue

1

First Page

23

Last Page

29

Keywords

Antibiotics; Comparative effectiveness; Hospitalized; Pediatric; Pneumonia

Comments

Grant support

• K23 AI104779/AI/NIAID NIH HHS/United States

Recommended Citation

Queen, M., Myers, A., Hall, M., Shah, S. S., Williams, D. J., Auger, K. A., Jerardi, K. E., Statile, A. M., Tieder, J. S. Comparative effectiveness of empiric antibiotics for community-acquired pneumonia Pediatrics 133, 23-29 (2014).