• Pediatrics · Jan 2014

    Multicenter Study Comparative Study

    Comparative effectiveness of empiric antibiotics for community-acquired pneumonia.

    • Mary Ann Queen, Angela L Myers, Matthew Hall, Samir S Shah, Derek J Williams, Katherine A Auger, Karen E Jerardi, Angela M Statile, and Joel S Tieder.
    • Division of Pediatric Hospital Medicine, Children's Mercy Hospitals & Clinics, 2401 Gillham Rd, Kansas City, MO 64108. mqueen@cmh.edu.
    • Pediatrics. 2014 Jan 1;133(1):e23-9.

    Background And ObjectiveNarrow-spectrum antibiotics are recommended as the first-line agent for children hospitalized with community-acquired pneumonia (CAP). There is little scientific evidence to support that this consensus-based recommendation is as effective as the more commonly used broad-spectrum antibiotics. The objective was to compare the effectiveness of empiric treatment with narrow-spectrum therapy versus broad-spectrum therapy for children hospitalized with uncomplicated CAP.MethodsThis multicenter retrospective cohort study using medical records included children aged 2 months to 18 years at 4 children's hospitals in 2010 with a discharge diagnosis of CAP. Patients receiving either narrow-spectrum or broad-spectrum therapy in the first 2 days of hospitalization were eligible. Patients were matched by using propensity scores that determined each patient's likelihood of receiving empiric narrow or broad coverage. A multivariate logistic regression analysis evaluated the relationship between antibiotic and hospital length of stay (LOS), 7-day readmission, standardized daily costs, duration of fever, and duration of supplemental oxygen.ResultsAmong 492 patients, 52% were empirically treated with a narrow-spectrum agent and 48% with a broad-spectrum agent. In the adjusted analysis, the narrow-spectrum group had a 10-hour shorter LOS (P = .04). There was no significant difference in duration of oxygen, duration of fever, or readmission. When modeled for LOS, there was no difference in average daily standardized cost (P = .62) or average daily standardized pharmacy cost (P = .26).ConclusionsCompared with broad-spectrum agents, narrow-spectrum antibiotic coverage is associated with similar outcomes. Our findings support national consensus recommendations for the use of narrow-spectrum antibiotics in children hospitalized with CAP.

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