RT Journal Article
SR Electronic
T1 Impact of a Guideline on Management of Children Hospitalized With Community-Acquired Pneumonia
JF Pediatrics
JO Pediatrics
FD American Academy of Pediatrics
SP e597
OP e604
DO 10.1542/peds.2011-1533
VO 129
IS 3
A1 Newman, Ross E.
A1 Hedican, Erin B.
A1 Herigon, Joshua C.
A1 Williams, David D.
A1 Williams, Arthur R.
A1 Newland, Jason G.
YR 2012
UL http://pediatrics.aappublications.org/content/129/3/e597.abstract
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