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
. 2023 Oct 28;23(1):542.
doi: 10.1186/s12887-023-04355-w.

Quality of antibiotic prescribing for pediatric community-acquired Pneumonia in outpatient care

Ariana Saatchi  1 , Manon R Haverkate  1 , Jennifer N Reid  2 , Salimah Z Shariff  2 , Marcus Povitz  3 , David M Patrick  4   5 , Michael Silverman  6 , Andrew M Morris  7 , James McCormack  1 , Fawziah Marra  8
Affiliations

Quality of antibiotic prescribing for pediatric community-acquired Pneumonia in outpatient care

Ariana Saatchi et al. BMC Pediatr. .

Abstract

Background: Antibiotics remain the primary treatment for community acquired pneumonia (CAP), however rising rates of antimicrobial resistance may jeopardize their future efficacy. With higher rates of disease reported in the youngest populations, effective treatment courses for pediatric pneumonia are of paramount importance. This study is the first to examine the quality of pediatric antibiotic use by agent, dose and duration.

Methods: A retrospective cohort study included all outpatient/primary care physician visits for pediatric CAP (aged < 19 years) between January 1 2014 to December 31 2018. Relevant practice guidelines were identified, and treatment recommendations extracted. Amoxicillin was the primary first-line agent for pediatric CAP. Categories of prescribing included: guideline adherent, effective but unnecessary (excess dose and/or duration), under treatment (insufficient dose and/or duration), and not recommended. Proportions of attributable-antibiotic use were examined by prescribing category, and then stratified by age and sex.

Result(s): A total of 42,452 episodes of pediatric CAP were identified. Of those, 31,347 (76%) resulted in an antibiotic prescription. Amoxicillin accounted for 51% of all prescriptions. Overall, 27% of prescribing was fully guideline adherent, 19% effective but unnecessary, 10% under treatment, and 44% not recommended by agent. Excessive duration was the hallmark of effective but unnecessary prescribing (97%) Macrolides accounted for the majority on non-first line agent use, with only 32% of not recommended prescribing preceded by a previous course of antibiotics.

Conclusion(s): This study is the first in Canada to examine prescribing quality for pediatric CAP by agent, dose and duration. Utilizing first-line agents, and shorter-course treatments are targets for stewardship.

Keywords: Antimicrobials; Appropriate prescribing; Community acquired Pneumonia; Outpatient care; Pediatrics; Stewardship.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Percentage of outpatient antibiotic use for pediatric CAP by category of prescription quality by year
Fig. 2
Fig. 2
Overall percentage of outpatient antibiotic use for pediatric CAP by category of prescription quality by age
See this image and copyright information in PMC

References

    1. Bryce J, Boschi-Pinto C, Shibuya K, Black RE. WHO estimates of the causes of death in children. The Lancet. 2005;365(9465):1147–52. doi: 10.1016/S0140-6736(05)71877-8. - DOI - PubMed
    1. McNeil SA, Qizilbash N, Ye J, Gray S, Zanotti G, Munson S, et al. A retrospective study of the clinical burden of hospitalized all-cause and pneumococcal Pneumonia in Canada. Can Respir J. 2016;2016:e3605834. doi: 10.1155/2016/3605834. - DOI - PMC - PubMed
    1. Vadlamudi NK, Saatchi A, Patrick DM, Rose C, Sadatsafavi M, Marra F. Impact of the 13-valent pneumococcal conjugate vaccine on acute otitis media and acute sinusitis epidemiology in British Columbia, Canada. J Antimicrob Chemother. 2021;76(9):2419–27. doi: 10.1093/jac/dkab167. - DOI - PubMed
    1. Le Saux N, Robinson JL. Uncomplicated Pneumonia in healthy Canadian children and youth: practice points for management. Paediatr Child Health. 2015;20(8):441–5. doi: 10.1093/pch/20.8.441. - DOI - PMC - PubMed
    1. Jain S, Williams DJ, Arnold SR, Ampofo K, Bramley AM, Reed C, et al. Community-Acquired Pneumonia requiring hospitalization among U.S. children. N Engl J Med. 2015;372(9):835–45. doi: 10.1056/NEJMoa1405870. - DOI - PMC - PubMed

Publication types

Grants and funding