Comparative effectiveness of empiric antibiotics for community-acquired pneumonia

Narrow-spectrum antibiotics are recommended as the first-line agent for children hospitalized with community-acquired pneumonia (CAP). There is little scientific evidence to support that this consensus-based recommendation is as effective as the more commonly used broad-spectrum antibiotics. The obj...

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Veröffentlicht in:Pediatrics (Evanston) 2014-01, Vol.133 (1), p.e23-e29
Hauptverfasser: Queen, Mary Ann, Myers, Angela L, Hall, Matthew, Shah, Samir S, Williams, Derek J, Auger, Katherine A, Jerardi, Karen E, Statile, Angela M, Tieder, Joel S
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container_issue 1
container_start_page e23
container_title Pediatrics (Evanston)
container_volume 133
creator Queen, Mary Ann
Myers, Angela L
Hall, Matthew
Shah, Samir S
Williams, Derek J
Auger, Katherine A
Jerardi, Karen E
Statile, Angela M
Tieder, Joel S
description Narrow-spectrum antibiotics are recommended as the first-line agent for children hospitalized with community-acquired pneumonia (CAP). There is little scientific evidence to support that this consensus-based recommendation is as effective as the more commonly used broad-spectrum antibiotics. The objective was to compare the effectiveness of empiric treatment with narrow-spectrum therapy versus broad-spectrum therapy for children hospitalized with uncomplicated CAP. This multicenter retrospective cohort study using medical records included children aged 2 months to 18 years at 4 children's hospitals in 2010 with a discharge diagnosis of CAP. Patients receiving either narrow-spectrum or broad-spectrum therapy in the first 2 days of hospitalization were eligible. Patients were matched by using propensity scores that determined each patient's likelihood of receiving empiric narrow or broad coverage. A multivariate logistic regression analysis evaluated the relationship between antibiotic and hospital length of stay (LOS), 7-day readmission, standardized daily costs, duration of fever, and duration of supplemental oxygen. Among 492 patients, 52% were empirically treated with a narrow-spectrum agent and 48% with a broad-spectrum agent. In the adjusted analysis, the narrow-spectrum group had a 10-hour shorter LOS (P = .04). There was no significant difference in duration of oxygen, duration of fever, or readmission. When modeled for LOS, there was no difference in average daily standardized cost (P = .62) or average daily standardized pharmacy cost (P = .26). Compared with broad-spectrum agents, narrow-spectrum antibiotic coverage is associated with similar outcomes. Our findings support national consensus recommendations for the use of narrow-spectrum antibiotics in children hospitalized with CAP.
doi_str_mv 10.1542/peds.2013-1773
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There is little scientific evidence to support that this consensus-based recommendation is as effective as the more commonly used broad-spectrum antibiotics. The objective was to compare the effectiveness of empiric treatment with narrow-spectrum therapy versus broad-spectrum therapy for children hospitalized with uncomplicated CAP. This multicenter retrospective cohort study using medical records included children aged 2 months to 18 years at 4 children's hospitals in 2010 with a discharge diagnosis of CAP. Patients receiving either narrow-spectrum or broad-spectrum therapy in the first 2 days of hospitalization were eligible. Patients were matched by using propensity scores that determined each patient's likelihood of receiving empiric narrow or broad coverage. A multivariate logistic regression analysis evaluated the relationship between antibiotic and hospital length of stay (LOS), 7-day readmission, standardized daily costs, duration of fever, and duration of supplemental oxygen. 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subjects Adolescent
Anti-Bacterial Agents - therapeutic use
Antibiotics
Bacterial pneumonia
Care and treatment
Cephalosporins - therapeutic use
Child
Child, Preschool
Children
Cohort Studies
Community-acquired infections
Community-Acquired Infections - drug therapy
Comparative Effectiveness Research
Comparative studies
Effectiveness studies
Evaluation
Female
Fluoroquinolones - therapeutic use
Health aspects
Hospitalization
Hospitals, Pediatric
Humans
Infant
Logistic Models
Macrolides - therapeutic use
Male
Matched-Pair Analysis
Multivariate Analysis
Pediatrics
Penicillins - therapeutic use
Pneumonia
Pneumonia - drug therapy
Propensity Score
Regression analysis
Retrospective Studies
Treatment Outcome
title Comparative effectiveness of empiric antibiotics for community-acquired pneumonia
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