Ambroggio Lilliam, Test Matthew, Metlay Joshua P, Graf Thomas R, Blosky Mary Ann, Macaluso Maurizio, Shah Samir S
From the *Division of Hospital Medicine, †Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; ‡General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts; §Population Health, Geisinger Health System, Danville, Pennsylvania; ¶Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; and ‖Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Pediatr Infect Dis J. 2015 Aug;34(8):839-42. doi: 10.1097/INF.0000000000000740.
Most children diagnosed with community-acquired pneumonia (CAP) are treated in the outpatient setting. The objective of this study was to determine the comparative clinical effectiveness of beta-lactam monotherapy and macrolide monotherapy in this population.
Children, 1-18 years old, with a clinical diagnosis of CAP at an outpatient practice affiliated (n = 71) with Geisinger Health System during January 1, 2008 to January 31, 2010 were eligible. The primary exposure was receipt of beta-lactam or macrolide monotherapy. The primary outcome was treatment failure defined as change in antibiotic prescription within 14 days of the initial pneumonia diagnosis. Propensity scores were used to determine the likelihood of receiving macrolide monotherapy. Treatment groups were matched 1:1, based on propensity score, age group and asthma status. Multivariable conditional logistic regression models estimated the association between macrolide monotherapy and treatment failures.
Of 1999 children with CAP, 1164 were matched. In the matched cohorts, 24% of children had asthma. Patients who received macrolide monotherapy had no statistical difference in treatment failure regardless of age when compared with patients who received beta-lactam monotherapy.
Our findings suggest that children diagnosed with CAP in the outpatient setting and treated with beta-lactam or macrolide monotherapy have the same likelihood to fail treatment regardless of age.
大多数被诊断为社区获得性肺炎（CAP）的儿童在门诊接受治疗。本研究的目的是确定β-内酰胺单药治疗和大环内酯单药治疗在该人群中的相对临床疗效。
纳入2008年1月1日至2010年1月31日期间在与盖辛格医疗系统相关的门诊诊所（n = 71）临床诊断为CAP的1 - 18岁儿童。主要暴露因素是接受β-内酰胺或大环内酯单药治疗。主要结局是治疗失败，定义为在初始肺炎诊断后14天内抗生素处方的改变。使用倾向评分来确定接受大环内酯单药治疗的可能性。根据倾向评分、年龄组和哮喘状态将治疗组进行1:1匹配。多变量条件逻辑回归模型估计大环内酯单药治疗与治疗失败之间的关联。
1999例CAP儿童中，1164例进行了匹配。在匹配队列中，24%的儿童患有哮喘。与接受β-内酰胺单药治疗的患者相比，接受大环内酯单药治疗的患者无论年龄大小，治疗失败率均无统计学差异。
我们的研究结果表明，在门诊被诊断为CAP并接受β-内酰胺或大环内酯单药治疗的儿童，无论年龄大小，治疗失败的可能性相同。
