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 |
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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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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.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.2013-1773</identifier><identifier>PMID: 24324001</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>United States: American Academy of Pediatrics</publisher><subject>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</subject><ispartof>Pediatrics (Evanston), 2014-01, Vol.133 (1), p.e23-e29</ispartof><rights>Copyright American Academy of Pediatrics Jan 2014</rights><rights>Copyright © 2014 by the American Academy of Pediatrics 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c456t-d3bd1a150c601c875d0c4fa9a84364c8707554df682fdc1ad61950b89c87dccb3</citedby><cites>FETCH-LOGICAL-c456t-d3bd1a150c601c875d0c4fa9a84364c8707554df682fdc1ad61950b89c87dccb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24324001$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Queen, Mary Ann</creatorcontrib><creatorcontrib>Myers, Angela L</creatorcontrib><creatorcontrib>Hall, Matthew</creatorcontrib><creatorcontrib>Shah, Samir S</creatorcontrib><creatorcontrib>Williams, Derek J</creatorcontrib><creatorcontrib>Auger, Katherine A</creatorcontrib><creatorcontrib>Jerardi, Karen E</creatorcontrib><creatorcontrib>Statile, Angela M</creatorcontrib><creatorcontrib>Tieder, Joel S</creatorcontrib><title>Comparative effectiveness of empiric antibiotics for community-acquired pneumonia</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><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.</description><subject>Adolescent</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Bacterial pneumonia</subject><subject>Care and treatment</subject><subject>Cephalosporins - therapeutic use</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Cohort Studies</subject><subject>Community-acquired infections</subject><subject>Community-Acquired Infections - drug therapy</subject><subject>Comparative Effectiveness Research</subject><subject>Comparative studies</subject><subject>Effectiveness studies</subject><subject>Evaluation</subject><subject>Female</subject><subject>Fluoroquinolones - therapeutic use</subject><subject>Health aspects</subject><subject>Hospitalization</subject><subject>Hospitals, Pediatric</subject><subject>Humans</subject><subject>Infant</subject><subject>Logistic Models</subject><subject>Macrolides - therapeutic use</subject><subject>Male</subject><subject>Matched-Pair Analysis</subject><subject>Multivariate Analysis</subject><subject>Pediatrics</subject><subject>Penicillins - therapeutic use</subject><subject>Pneumonia</subject><subject>Pneumonia - drug therapy</subject><subject>Propensity Score</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkc-L1TAQx4Mo7vPp1aMUvHjpc9IkTXsRloe_YGER9BzSZPrM0ibdJF3c_96Uty7qKWHmk2G--RDymsKBCt68X9CmQwOU1VRK9oTsKPRdzRspnpIdAKM1BxAX5EVKNwDAhWyek4uGs6bU6Y58O4Z50VFnd4cVjiOa7eYxpSqMFc6Li85U2mc3uJCdSdUYYmXCPK_e5ftam9vVRbTV4nGdg3f6JXk26inhq4dzT358-vj9-KW-uv789Xh5VRsu2lxbNliqqQDTAjWdFBYMH3WvO85aXgogheB2bLtmtIZq29JewND1pWWNGdiefDjPXdZhRmvQ56gntUQ363ivgnbq3453P9Up3CkumIDyA3vy7mFADLcrpqxmlwxOk_YY1qQo70GyrulEQd_-h96ENfoSr1Cy5b08U_WZOukJlfMm-Iy_sgnThCdUJf3xWl0yCaJve9YU_nDmTQwpRRwfl6egNrtqs6s2u2qzWx68-TvyI_5HJ_sNyIyhow</recordid><startdate>201401</startdate><enddate>201401</enddate><creator>Queen, Mary Ann</creator><creator>Myers, Angela L</creator><creator>Hall, Matthew</creator><creator>Shah, Samir S</creator><creator>Williams, Derek J</creator><creator>Auger, Katherine A</creator><creator>Jerardi, Karen E</creator><creator>Statile, Angela M</creator><creator>Tieder, Joel S</creator><general>American Academy of Pediatrics</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201401</creationdate><title>Comparative effectiveness of empiric antibiotics for community-acquired pneumonia</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c456t-d3bd1a150c601c875d0c4fa9a84364c8707554df682fdc1ad61950b89c87dccb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adolescent</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotics</topic><topic>Bacterial pneumonia</topic><topic>Care and treatment</topic><topic>Cephalosporins - therapeutic use</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Cohort Studies</topic><topic>Community-acquired infections</topic><topic>Community-Acquired Infections - drug therapy</topic><topic>Comparative Effectiveness Research</topic><topic>Comparative studies</topic><topic>Effectiveness studies</topic><topic>Evaluation</topic><topic>Female</topic><topic>Fluoroquinolones - therapeutic use</topic><topic>Health aspects</topic><topic>Hospitalization</topic><topic>Hospitals, Pediatric</topic><topic>Humans</topic><topic>Infant</topic><topic>Logistic Models</topic><topic>Macrolides - therapeutic use</topic><topic>Male</topic><topic>Matched-Pair Analysis</topic><topic>Multivariate Analysis</topic><topic>Pediatrics</topic><topic>Penicillins - therapeutic use</topic><topic>Pneumonia</topic><topic>Pneumonia - drug therapy</topic><topic>Propensity Score</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Queen, Mary Ann</creatorcontrib><creatorcontrib>Myers, Angela L</creatorcontrib><creatorcontrib>Hall, Matthew</creatorcontrib><creatorcontrib>Shah, Samir S</creatorcontrib><creatorcontrib>Williams, Derek J</creatorcontrib><creatorcontrib>Auger, Katherine A</creatorcontrib><creatorcontrib>Jerardi, Karen E</creatorcontrib><creatorcontrib>Statile, Angela M</creatorcontrib><creatorcontrib>Tieder, Joel S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Queen, Mary Ann</au><au>Myers, Angela L</au><au>Hall, Matthew</au><au>Shah, Samir S</au><au>Williams, Derek J</au><au>Auger, Katherine A</au><au>Jerardi, Karen E</au><au>Statile, Angela M</au><au>Tieder, Joel S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparative effectiveness of empiric antibiotics for community-acquired pneumonia</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2014-01</date><risdate>2014</risdate><volume>133</volume><issue>1</issue><spage>e23</spage><epage>e29</epage><pages>e23-e29</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><coden>PEDIAU</coden><abstract>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.</abstract><cop>United States</cop><pub>American Academy of Pediatrics</pub><pmid>24324001</pmid><doi>10.1542/peds.2013-1773</doi><oa>free_for_read</oa></addata></record> |
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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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