Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2014 Jan;133(1):e23-9.
doi: 10.1542/peds.2013-1773. Epub 2013 Dec 9.

Comparative effectiveness of empiric antibiotics for community-acquired pneumonia

Mary Ann Queen  1 , Angela L Myers, Matthew Hall, Samir S Shah, Derek J Williams, Katherine A Auger, Karen E Jerardi, Angela M Statile, Joel S Tieder
Affiliations
Comparative Study

Comparative effectiveness of empiric antibiotics for community-acquired pneumonia

Mary Ann Queen et al. Pediatrics. 2014 Jan.

Abstract

Background and objective: Narrow-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.

Methods: This 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.

Results: Among 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).

Conclusions: Compared 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.

Keywords: antibiotics; comparative effectiveness; hospitalized; pediatric; pneumonia.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Consort diagram indicating identification of study population and reasons for exclusion. aFluoroquinolone exposure, n = 12; second- and third-generation cephalosporins only, n = 224.
See this image and copyright information in PMC

References

    1. Lee GE, Lorch SA, Sheffler-Collins S, Kronman MP, Shah SS. National hospitalization trends for pediatric pneumonia and associated complications. Pediatrics. 2010;126(2):204–213 - PMC - PubMed
    1. Keren R, Luan X, Localio R, et al. Pediatric Research in Inpatient Settings (PRIS) Network . Prioritization of comparative effectiveness research topics in hospital pediatrics. Arch Pediatr Adolesc Med. 2012;166(12):1155–1164 - PubMed
    1. Brogan TV, Hall M, Williams DJ, et al. . Variability in processes of care and outcomes among children hospitalized with community-acquired pneumonia. Pediatr Infect Dis J. 2012;31(10):1036–1041 - PMC - PubMed
    1. Ambroggio L, Tabb LP, O’Meara T, Sheffler-Collins S, McGowan KL, Shah SS. Influence of antibiotic susceptibility patterns on empiric antibiotic prescribing for children hospitalized with community-acquired pneumonia. Pediatr Infect Dis J. 2012;31(4):331–336 - PMC - PubMed
    1. Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25–76 - PMC - PubMed

MeSH terms