No Antibiotics for Pediatric Pneumonia?
April 23, 2020
Written by Aaron Lacy
Spoon Feed
In children discharged with a diagnosis of community-acquired pneumonia (CAP), there was no difference in treatment failure or parent-reported quality-of-life measures between those who received antibiotics and those who did not.
Why does this matter?
All medications are associated with potential adverse effects, and antibiotic resistance is growing. If children with CAP can recover without antibiotics, why add to possible complications and to resistance?
Can’t you just prescribe my kid some antibiotics?
This was a secondary analysis from a prospective cohort of children who presented to a tertiary-care pediatric ED with suspected CAP. Children in either the antibiotic exposure group or no antibiotic exposure group were propensity matched, including severity of symptoms at the time of presentation. 294 children (Mean age = 3.4 years) were included, with 49.9% receiving antibiotics. There was no statistical difference in treatment failure, the primary outcome (table below).
Additionally, there was no statistical difference in quality-of-life measures in those who received antibiotics versus those who did not. These measures included diarrhea (17.0% Rx versus 20.4% w/o), vomiting (15.0% Rx versus 12.9% w/o), abdominal pain (15.0% Rx versus 12.9% w/o) and time to resolution of symptoms. Most CAP in children is viral, and previous studies have shown that scaling back antibiotics in children is safe. This study lays the groundwork for a placebo-controlled study of antibiotics in children with CAP.
Editor’s note: Until then, it’s a pretty hard sell to have a child with CAP and withhold antibiotic treatment. ~Clay Smith
Source
Antibiotic Use and Outcomes in Children in the Emergency Department With Suspected Pneumonia. Pediatrics. 2020 Mar 16. pii: e20193138. doi: 10.1542/peds.2019-3138. [Epub ahead of print]
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