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
. 2024 Oct 1;7(10):e2441821.
doi: 10.1001/jamanetworkopen.2024.41821.

Outpatient Antibiotic Use and Treatment Failure Among Children With Pneumonia

Daniel J Shapiro  1 , Matt Hall  2 , Mark I Neuman  3 , Adam L Hersh  4 , Jillian M Cotter  5 , Jonathan D Cogen  6 , Thomas V Brogan  7 , Lilliam Ambroggio  8 , Anne J Blaschke  4 , Susan C Lipsett  3 , Jeffrey S Gerber  9 , Todd A Florin  10   11
Affiliations

Outpatient Antibiotic Use and Treatment Failure Among Children With Pneumonia

Daniel J Shapiro et al. JAMA Netw Open. .

Abstract

Importance: Although a viral etiology can be detected in most cases of pediatric pneumonia, antibiotic treatment is common. The effectiveness of antibiotics in the outpatient setting for children diagnosed with pneumonia is not known.

Objective: To compare outcomes among children diagnosed with pneumonia who were and were not treated with oral antibiotics.

Design, setting, and participants: This retrospective cohort study identified Medicaid-insured children and adolescents 17 years or younger diagnosed with pneumonia and discharged from ambulatory settings in a multistate claims database from January 1, 2017, to December 31, 2019. Propensity score matching was used to mitigate confounding. Data were analyzed from August 31, 2023, to August 16, 2024.

Exposures: Antibiotic receipt, defined as an oral antibiotic dispensed from a pharmacy on the day of the index visit or on the subsequent day. Children who did not receive antibiotics included those who were not prescribed antibiotics and those who were prescribed antibiotics but did not fill the prescription.

Main outcomes and measures: Treatment failure and severe outcomes within 2 to 14 days after the index visit. Treatment failure included hospitalization or ambulatory revisits for pneumonia, new antibiotic dispensation with a same-day ambulatory visit, or complicated pneumonia. Severe outcomes included hospitalization for pneumonia or complicated pneumonia.

Results: Among the 103 854 children with pneumonia included in the analysis, the median age was 5 (IQR, 2-9) years, and 54 665 (52.6%) were male. Overall, 20 435 children (19.7%) did not receive an antibiotic within 1 day. The propensity score-matched analysis included 40 454 children (20 227 per group). Treatment failure occurred in 2167 children (10.7%) who did not receive antibiotics and 1766 (8.7%) who received antibiotics (risk difference, 1.98 [95% CI, 1.41-2.56] percentage points). Severe outcomes occurred in 234 of 20 435 children (1.1%) who did not receive antibiotics and in 133 of 83 419 (0.7%) who did (risk difference, 0.46 [95% CI, 0.28-0.64] percentage points).

Conclusions and relevance: In this cohort study of children diagnosed with pneumonia in ambulatory settings, almost 20% did not receive antibiotics within a day of diagnosis. Although not receiving antibiotics was associated with a small increase in the risk of treatment failure, severe outcomes were uncommon regardless of whether antibiotics were received. These results suggest that some children diagnosed with pneumonia can likely be managed without antibiotics and highlight the need for prospective studies to identify these children.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Cotter reported receiving grant funding from Pfizer Inc outside the submitted work. Dr Ambroggio reported receiving grant funding from Pfizer Inc outside the submitted work. Dr Blaschke reported receiving consulting fees from BioFire Diagnostics/bioMérieux and Merck & Co Inc outside the submitted work and having a patent for intellectual property related to the FilmArray Diagnostic System with royalties paid from BioFire Diagnostics/bioMérieux through the University of Utah. Dr Florin reported receiving grant funding from the National Heart, Lung, and Blood Institute and Pfizer Inc and speaker fees from DiaSorin and Medscape outside the submitted work. No other disclosures were reported.

References

    1. Poole NM, Shapiro DJ, Kronman MP, Hersh AL. Ambulatory antibiotic prescribing for children with pneumonia after publication of national guidelines: a cross-sectional retrospective study. Infect Dis Ther. 2020;9(1):69-76. doi:10.1007/s40121-019-00276-3 - DOI - PMC - PubMed
    1. Jain S, Williams DJ, Arnold SR, et al. ; CDC EPIC Study Team . Community-acquired pneumonia requiring hospitalization among US children. N Engl J Med. 2015;372(9):835-845. doi:10.1056/NEJMoa1405870 - DOI - PMC - PubMed
    1. Yun KW, Wallihan R, Desai A, et al. ; Children’s Hospitals Initiative for Research in Pneumonia . Clinical characteristics and etiology of community-acquired pneumonia in US children, 2015-2018. Pediatr Infect Dis J. 2022;41(5):381-387. doi:10.1097/INF.0000000000003475 - DOI - PubMed
    1. Bradley JS, Byington CL, Shah SS, et al. ; Pediatric Infectious Diseases Society and the Infectious Diseases Society of America . 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-e76. doi:10.1093/cid/cir531 - DOI - PMC - PubMed
    1. Florin TA, Byczkowski T, Gerber JS, Ruddy R, Kuppermann N. Diagnostic testing and antibiotic use in young children with community-acquired pneumonia in the United States, 2008-2015. J Pediatric Infect Dis Soc. 2020;9(2):248-252. doi:10.1093/jpids/piz026 - DOI - PMC - PubMed

Publication types

Substances