Antibiotic Choice in Ambulatory Children with Community-Acquired Pneumonia

The goal of a study published in The Journal of Pediatrics was to describe the antibiotic prescribing patterns in ambulatory children with community-acquired pneumonia (CAP) and to assess the association between antibiotic selection and the clinical outcomes.

In this retrospective cohort study, ambulatory Medicaid-enrolled children, 0-18 years of age, diagnosed with CAP between 2010 and 2016 were included. Children were exposed to the antibiotic classes: narrow-spectrum – aminopenicillins; broad-spectrum – amoxicillin/clavulanate and cephalosporins; macrolide monotherapy; macrolides with narrow-spectrum antibiotics; or macrolides with broad-spectrum antibiotics.

Overall, 252 177 children were diagnosed with CAP among the outpatient department visits. Among these, 43.2% received macrolide monotherapy; 26.1% were given narrow-spectrum antibiotics; and 24.7% were prescribed broad-spectrum antibiotics. Overall, 1,488 children were hospitalized while 117developed severe pneumonia. 

The findings depicted greater odds for subsequent hospitalization among children receiving broad-spectrum antibiotics compared to those who received narrow-spectrum antibiotics. While the odd for hospitalization were lower among those receiving macrolide monotherapy and macrolides with narrow-spectrum antibiotics. On the other hand, children receiving macrolide monotherapy had lower predilection for severe pneumonia than those receiving narrow-spectrum antibiotics. 

From the results it was concluded that macrolides are the most commonly prescribed antibiotics for ambulatory children with CAP. In this population, subsequent hospitalization and severe pneumonia are rare. It was suggested the reductions in broad-spectrum and macrolide antibiotic prescriptions should be practiced in these patient populations.

Source: The Journal of Pediatrics. 2021 Feb;229:207-215.e1. doi: 10.1016/j.jpeds.2020.10.005.