Antibiotic choices for treating children with pneumonia

Vanderbilt-led research shows hospitals are doing a better job of using antibiotics less commonly associated with antibiotic resistance to treat children hospitalized with community-acquired pneumonia (CAP).

The report, “Antibiotic choice for children hospitalized with pneumonia and adherence to national guidelines,” appeared in the journal Pediatrics.

This study was nested within a larger study, the Centers for Disease Control and Prevention (CDC) Etiology of Pneumonia in the Community (EPIC). The multi-center EPIC study was a prospective, population-based study of community-acquired pneumonia hospitalizations among children in the United States that sought to address critical gaps in the knowledge about pneumonia.

Study authors examined the impact and implementation of national guidelines, published in 2011, that call for prescribing penicillin or ampicillin, known as narrow-spectrum antibiotics, to treat most children hospitalized with pneumonia.

Prior to the new prescribing guidelines, third-generation cephalosporins, a broader-spectrum class of antibiotics, were commonly used. Results showed that after the release of the guidelines, hospitals were less likely to prescribe third-generation cephalosporins, using it about 44.8 percent of the time by the end of the study compared with 57.3 percent use expected from pre-guidelines trends. After the guidelines release, the use of narrow-spectrum antibiotics increased from 3.9 percent to 15.2 percent.

“Third-generation cephalosporins are broader-spectrum antibiotics (compared to ampicillin) and are unnecessary for the treatment of uncomplicated pneumonia in children. Their use contributes to antibiotic resistance, a major public health problem, both nationally and globally,” said study lead author Derek Williams, M.D., MPH, assistant professor of Pediatrics, and a member of the Vanderbilt Vaccine Research Program and the Division of Hospital Medicine.

From January 2010 to June 2012, children who were admitted with pneumonia at Monroe Carell Jr. Children’s Hospital at Vanderbilt, LeBonheur Children’s Medical Center and the University of Utah were recruited for the EPIC study. Researchers enrolled 2,638 children younger than 18, but for the current study 507 children who did not receive antibiotics or were younger than 3 months of age were excluded. The final study population included 2,121 children.

Other Vanderbilt researchers for the EPIC study include: Carlos G. Grijalva, M.D., MPH, Kathryn Edwards, M.D., Jim Chappell, M.D., Ph.D., Wesley Self, M.D., MPH, and Yuwei Zhu, M.D., MS.

The EPIC study was funded by the CDC’s Influenza Division of the National Center for Immunization and Respiratory Diseases.

– by Christina Echegaray