• Jillian M Cotter, Todd A Florin, Angela Moss, Krithika Suresh, Nidhya Navanandan, Sriram Ramgopal, Samir S Shah, Richard Ruddy, Allison Kempe, and Lilliam Ambroggio.
• Section of Hospital Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA.
• J Hosp Med. 2022 Dec 1; 17 (12): 975983975-983.

BackgroundAlthough viral etiologies predominate, antibiotics are frequently prescribed for community-acquired pneumonia (CAP).ObjectiveWe evaluated the association between antibiotic use and outcomes among children hospitalized with suspected CAP.Designs, Settings And ParticipantsWe performed a secondary analysis of a prospective cohort of children hospitalized with suspected CAP.InterventionThe exposure was the receipt of antibiotics in the emergency department (ED).Main Outcome And MeasuresClinical outcomes included length of stay (LOS), care escalation, postdischarge treatment failure, 30-day ED revisit, and quality-of-life (QoL) measures from a follow-up survey 7-15 days post discharge. To minimize confounding by indication (e.g., radiographic CAP), we performed inverse probability treatment weighting with propensity analyses.ResultsAmong 523 children, 66% were <5 years, 88% were febrile, 55% had radiographic CAP, and 55% received ED antibiotics. The median LOS was 41 h (IQR: 25, 54). After propensity analyses, there were no differences in LOS, escalated care, treatment failure, or revisits between children who received antibiotics and those who did not. Seventy-one percent of patients completed follow-up surveys after discharge. Among 16% of patients with fevers after discharge, the median fever duration was 2 days, and those who received antibiotics had a 37% decrease in the mean number of days with fever (95% confidence interval: 20% and 51%). We found no statistical differences in other QoL measures.© 2022 Society of Hospital Medicine.

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