Child/Adolescent Health

Implementing a clinical practice guideline helps children with pneumonia get proper antibiotics

About 2 percent of children will contract community-acquired pneumonia (CAP) each year. National guidelines recommend ampicillin (a narrow-spectrum antibiotic) to treat children hospitalized with uncomplicated CAP. This antibiotic targets the bacteria Streptococcus pneumonia, which causes most cases of pediatric CAP.

The researchers examined the impact of a large children's hospital's implementation of a clinical practice guideline that encouraged the use of ampicillin followed by the narrow-spectrum antibiotic amoxicillin at the time of hospital discharge for 5 to 7 days. Implementing the new guideline resulted in an increased use of ampicillin and a decline in use of broad-spectrum antibiotics (that target many types of bacteria) at hospital discharge.

The researchers collected data on 530 children hospitalized with CAP for 12 months prior to guideline implementation and on 503 children after the guideline was put into place. Prior to guideline implementation, 72 percent of children were treated with ceftriaxone; only 13 percent were treated with ampicillin. After 1 year of guideline implementation, the most commonly used antibiotic was ampicillin (63 percent). Overall, there was a 34 percent increase in the use of ampicillin following guideline implementation. Importantly, no increase in treatment failures or readmissions were observed due to this change.

The use of post-discharge antibiotics also changed, with a significant rise in the use of amoxicillin and a significant decrease in the use of cefdinir and other antibiotics. Although the guideline significantly improved antibiotic choice among providers, other recommendations such as the length of antibiotic therapy and obtaining blood cultures were not followed. The study was supported in part by the Agency for Healthcare Research and Quality (HS10399).

See "Impact of a guideline on management of children hospitalized with communityacquired pneumonia," by Ross E. Newman, D.O., Erin B. Hedican, M.P.H., Joshua C. Herigon, M.P.H., and others in the March 2012 Pediatrics 129(3), pp. e597-e604.

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