PT  - JOURNAL ARTICLE
AU  - Newman, Ross E.
AU  - Hedican, Erin B.
AU  - Herigon, Joshua C.
AU  - Williams, David D.
AU  - Williams, Arthur R.
AU  - Newland, Jason G.
TI  - Impact of a Guideline on Management of Children Hospitalized With Community-Acquired Pneumonia
AID  - 10.1542/peds.2011-1533
DP  - 2012 Mar 01
TA  - Pediatrics
PG  - e597--e604
VI  - 129
IP  - 3
4099  - http://pediatrics.aappublications.org/content/129/3/e597.short
4100  - http://pediatrics.aappublications.org/content/129/3/e597.full
SO  - Pediatrics2012 Mar 01; 129
AB  - OBJECTIVES: We sought to describe the impact a clinical practice guideline (CPG) had on antibiotic management of children hospitalized with community-acquired pneumonia (CAP).PATIENTS AND METHODS: We conducted a retrospective study of discharged patients from a children’s hospital with an ICD-9-CM code for pneumonia (480–486). Eligible patients were admitted from July 8, 2007, through July 9, 2009, 12 months before and after the CAP CPG was introduced. Three-stage least squares regression analyses were performed to examine hypothesized simultaneous relationships, including the impact of our institution\x{2019}s antimicrobial stewardship program (ASP).RESULTS: The final analysis included 1033 patients: 530 (51%) before the CPG (pre-CPG) and 503 (49%) after the CPG (post-CPG). Pre-CPG, ceftriaxone (72%) was the most commonly prescribed antibiotic, followed by ampicillin (13%). Post-CPG, the most common antibiotic was ampicillin (63%). The effect of the CPG was associated with a 34% increase in ampicillin use (P < .001). Discharge antibiotics also changed post-CPG, showing a significant increase in amoxicillin use (P < .001) and a significant decrease in cefdinir and amoxicillin/clavulanate (P < .001), with the combined effect of the CPG and ASP leading to 12% (P < 0.001) and 16% (P < .001) reduction, respectively. Overall, treatment failure was infrequent (1.5% vs 1%).CONCLUSIONS: A CPG and ASP led to the increase in use of ampicillin for children hospitalized with CAP. In addition, less broad-spectrum discharge antibiotics were used. Patient adverse outcomes were low, indicating that ampicillin is appropriate first-line therapy for otherwise healthy children admitted with uncomplicated CAP.Abbreviations:3SLS — 3-stage least squares regression analysisASP — antimicrobial stewardship programCAP — community-acquired pneumoniaCPG — clinical practice guidelineCXR — chest radiographICD-9-CM — International Classification of Diseases-Ninth Revision-Clinical ModificationIDSA — Infectious Diseases Society of AmericaVATS — video-assisted thoracoscopic surgery