Guideline-Concordant Antibiotic Use in Children With Community-Acquired Pneumonia

Abstract

Background: Despite national guidelines on appropriate antibiotic therapy, there is wide variation in antibiotic decision-making for children with community-acquired pneumonia. This study sought to determine prevalence and factors associated with guideline-concordant antibiotic use in children presenting with pneumonia to the emergency department (ED).

Methods: We enrolled children aged younger than 18 years presenting to the ED at 2 US children's hospitals between September 2017 and May 2019 with clinical and radiographic pneumonia. The primary outcome was guideline-concordant antibiotic use as defined by the 2011 Infectious Diseases Society of America pediatric pneumonia guideline and local expert consensus. Outcomes included proportion of antibiotic use and proportion of guideline-concordant treatment. We used multivariable logistic regression models to determine associations of comorbidities and functional limitations, clinical findings, and radiographic characteristics with overall antibiotic use and guideline-concordant treatment.

Results: Among 772 included children, 573 received antibiotics (74.2%), and 441 (57.1%) received guideline-concordant antibiotic treatment. Antibiotic initiation was less likely in those with interstitial findings on chest radiograph (adjusted odds ratio [aOR], 0.14; 95% CI, 0.07-0.25) and negative results or nonperformance of viral testing (aOR, 0.39; 95% CI, 0.24-0.65). Guideline-concordant treatment was more likely in those with chest indrawing (aOR, 2.22; 95% CI, 1.34-3.66) and less likely in those with clinically significant effusion (aOR, 0.21; 95% CI, 0.06-0.76).

Conclusions: Among children presenting to the ED with pneumonia, more than 40% received treatment inconsistent with guideline recommendations. These observations underscore opportunities to improve appropriate antibiotic use in this population.