Less Treatment Failure with Macrolide than Beta-Lactam Monotherapy in Children with CAP

SAN DIEGO, CA— School-aged children diagnosed with community-acquired pneumonia (CAP) in the outpatient setting are less likely to fail treatment when treated with macrolide monotherapy, study investigators reported at IDWeek 2012.

Lilliam Ambroggio, PhD, MPH, of Cincinnati Children's Hospital Medical Center, Cincinnati, OH, and colleagues compared the effectiveness of beta-lactam monotherapy — recommended by Pediatric Infectious Disease Society and Infectious Society Diseases of America guidelines — with macrolide monotherapy in children with CAP diagnosed in the outpatient setting.

Eligible patients included 1,999 children 1–18 years old with a clinical diagnosis of CAP at an outpatient practice affiliated with Geisinger Health System during January 1, 2008–December 31, 2009. The primary exposure was receipt of beta-lactam or macrolide monotherapy. The primary outcome was an unscheduled follow-up visit (e.g., outpatient, emergency department, or admitted as an inpatient) within 1–5 days of diagnosis. Propensity scores (e.g., age, respiratory complaint, receipt of albuterol, asthma, wheezes, crackles, retractions, receipt of systemic corticosteroids, fever, season of diagnosis, and chest x-ray) were used to determine the likelihood of receiving macrolide monotherapy. Treatment groups were matched 1:1, based on propensity score and asthma status.

A total of 1,190 children (60%) were matched. In the matched cohort, 595 children were placed in each treatment group, where 25% of children had asthma and 22% presented with wheezing. School-aged children (6–18 years) who received macrolide monotherapy were almost half as likely to have an unscheduled follow-up visit in the outpatient clinic or at the emergency department compared with school-aged children who received beta-lactam monotherapy.

When the cohort was stratified by age group, no statistical difference was found in preschool-aged children (1–5 years) who received macrolide monotherapy vs. preschool-aged children who received beta-lactam monotherapy.

“If unscheduled follow-up visits are considered a proxy for treatment failure, our findings suggest that school-aged but not preschool-aged children diagnosed with CAP in the outpatient setting are less likely to fail treatment when treated with macrolide monotherapy,” Dr. Ambroggio concluded, adding that “wheezing was not found to modify the effect estimates of the antibiotic therapy on unscheduled follow-up visit.”