Written by Kimiko Dunbar
Spoon Feed
Among children with community acquired pneumonia (CAP), only 57% receive guideline-concordant care. Children with retractions are more likely to receive guideline-concordant therapy, whereas those with clinically significant effusions are less likely.
I-D-S-A, who do we appreciate?
CAP is one of the most common pediatric diagnoses. Despite national guidelines, inappropriate antibiotic use is common, promoting resistance and adverse drug events. Little is known about the factors that contribute to guideline-concordant antibiotic treatment. This study examined guideline-concordant antibiotic use in children with CAP presenting the emergency departments. Using a prospective cohort design (n=772), 57.1% received guideline-concordant treatment. The presence of interstitial infiltrates (aOR 0.14, 95%CI 0.07 – 0.25) decreased antibiotic use. Further, a negative result on a respiratory pathogen panel, or a panel not being obtained (aOR 0.39, 95%CI 0.24 – 0.65), also reduced antibiotic use. The only positive factor associated with the initiation of guideline-concordant use was the presence of retractions (aOR, 2.22; 95%CI 1.34 – 3.66), and the only negative factor was the presence of a clinically significant effusion (aOR, 0.21; 95%CI 0.06 – 0.76). Of note, location of care, severity of pneumonia/effusion, and prior beta-lactam use were considered in guideline concordance. Giving no antibiotics was considered guideline-concordant, and azithromycin was not considered in determination of guideline concordance. Limitations include single-center generalizability and observational bias. Findings highlight opportunities for improved antibiotic stewardship in pediatric pneumonia management.
How does this change my practice?
It’s tempting to assume that a patient who appears sicker or more complicated justifies treatment outside of guideline-concordance due to fears of missing more severe or resistant pathogens. We are seeing increasing rates of complicated pneumonia, underscoring the importance of adhering to guidelines to prevent antibiotic resistance and adverse outcomes. This is a good reminder that guidelines exist not only for the patients presenting with garden-variety CAP, but also for the more complicated cases.
Sources
Guideline-Concordant Antibiotic Use in Children With Community-Acquired Pneumonia. Hosp Pediatr. 2025 Apr 1;15(4):300-308. doi: 10.1542/hpeds.2024-007994. PMID: 40031991
