Study highlights antibiotic stewardship targets in kids with pneumoniaA study of children hospitalized with community-acquired pneumonia (CAP) suggests that antibiotic decisions made in the emergency department (ED) have a significant impact on inpatient antibiotic use, researchers reported today in Pediatrics.The study also found and that nearly a third of children without radiographic evidence of pneumonia received antibiotics, suggesting overuse is common.In the prospective cohort study, which included children ages 3 months to 18 years who presented to the ED of a children's hospital with symptoms of a lower respiratory tract infection from July 2013 through December 2017, researchers estimated the risk factors associated with receipt of one or more doses of inpatient antibiotics and a full treatment course (5 or more days).
Of the 1,142 children enrolled, 477 (median age, 2.8 years) met the criteria for inclusion; 51% had radiographic CAP or equivocal chest radiograph (CXR), and 49% had non-radiographic CAP.Of the 477 children, 285 (60%) received at least one dose of antibiotics in the inpatient setting, and 254 (53%) received a full treatment course.
Most patients (90%) who received antibiotics in the ED received inpatient antibiotics. In adjusted analyses, receipt of antibiotics in the ED (relative risk [RR], 4.33; 95% confidence interval [CI], 2.63 to 7.13), history of fever (RR, 1.66; 95% CI, 1.22 to 2.27), and use of supplemental oxygen (RR, 1.29; 95% CI, 1.11 to 1.50) were associated with an increased risk of inpatient antibiotic use, with similar findings for a full treatment course.Children with radiographic CAP or equivocal CXRs had an increased risk of inpatient antibiotics compared with those with normal