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I enjoyed the article by Handy, et al on the variability in antibiotic prescribing for community-acquired pneumonia (CAP) in children within a large primary-care network, especially the use of electronic health record data to explore this issue. However, I disagree with their characterization that the Infectious Disease Society of America (IDSA) recommends amoxicillin as initial therapy for "most children with CAP". The IDSA guideline specifically states that "Macrolide antibiotics should be prescribed for treatment of children (primarily school-aged children and adolescents) evaluated in an outpatient setting with findings compatible with CAP caused by atypical pathogens". Other experts go even further in specifically recommending azithromycin as the first-line therapy for children 5 years and older with CAP (Barson, et al, "Community-acquired pneumonia in children: Outpatient treatment", UpToDate, Topic 5987 Version 35.0 updated 1/13/16). In light of these recommendations, I believe the authors should recognize the role of azithromycin as a reasonable first-line option for certain children with CAP.
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