Use of IDSA/PIDS Recommended First-Line Antibiotics for CAP Increasing

SAN FRANCISCOCA—Publication of the Pediatric Infectious Disease Society (PIDS)/Infectious Diseases Society of America (IDSA) treatment guidelines for children hospitalized with community acquired pneumonia (CAP) has resulted in the increased use of recommended antibiotic therapies for CAP, study investigators presented at IDWeek 2013.

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In October 2011, the PIDS and IDSA guidelines recommended amoxicillin, ampicillin or penicillin-G as first-line empiric therapy for CAP, but the impact of these recommendations on prescribing patterns was unknown.

Rachael K Ross, MPH, from The Children's Hospital of Philadelphia, Philadelphia, PA, and colleagues aimed to investigate the impact of the PIDS/IDSA guideline on antibiotic prescribing for pediatric patients hospitalized with CAP. They examined antibiotic use for CAP at 38 children's hospitals in children 6 months to 18 years of age who were discharged between October 1, 2010 and March 31, 2013, with a primary diagnosis of pneumonia.

Patients with complex chronic conditions, a secondary diagnosis of effusion or empyema, or ICU level of care (eg, mechanical ventilation or vasopressors on 2 consecutive days) were excluded from the analysis. The guideline recommended first-line antibiotic therapy was defined as any use of amoxicillin, ampicillin or penicillin.

Piece-wise longitudinal logistic models with a knot at October 2010 were fitted. To project and compare prescribing without the intervention, a simple logistic model for the pre-guideline data was fitted. Estimates were projected through September 2012.

Overall, 28% (10,813 of 38,951) of children with CAP received the recommended first-line therapy. A hospital-specific analysis of 18 hospitals showed considerable variation in both the level and trajectory of use of recommended first-line therapy before and after the guidelines. Specifically, 7 hospitals were considered guideline adopters, 7 had adopted or were adopting prior to guideline publication, and 4 were unable to be categorized.

The guideline publication resulted in an absolute increase in the probability of receiving recommended first-line therapy than pre-publication (projected 0.29, 95% CI: 0.18–0.43 vs. expected 0.43, 95% CI: 0.34–0.51). The probability of receiving cephalosporins continued to decrease at a similar rate (P=0.117) post-publication as it did during the pre-publication (P=0.02). In regards to azithromycin prescribing, the rate significantly declined post-publication (expected 0.31 vs. projected 0.41; P=0.001) than its rate pre-publication.

“Guideline adoption was not consistent across institutions,” Dr. Ross concluded. Further studies regarding the outcomes associated with and reasons for compliance with treatment guidelines are needed. 

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