Department of Pediatrics, Harvard Medical School, Boston, MA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
Children's Hospital Association, Lenexa, KS.
J Pediatr. 2021 Feb;229:207-215.e1. doi: 10.1016/j.jpeds.2020.10.005. Epub 2020 Oct 10.
To describe antibiotic prescribing patterns in ambulatory children with community-acquired pneumonia and to assess the relationship between antibiotic selection and clinical outcomes.
This was a retrospective cohort study of ambulatory Medicaid-enrolled children 0-18 years of age diagnosed with community-acquired pneumonia from 2010 to 2016. The exposure was antibiotic class: narrow-spectrum (aminopenicillins), broad-spectrum (amoxicillin/clavulanate and cephalosporins), macrolide monotherapy, macrolides with narrow-spectrum antibiotics, or macrolides with broad-spectrum antibiotics. The associations between antibiotic selection and the outcomes of subsequent hospitalization and development of severe pneumonia (chest drainage procedure, intensive care admission, mechanical ventilation) were assessed, controlling for measures of illness severity.
Among 252 177 outpatient pneumonia visits, macrolide monotherapy was used in 43.2%, narrow-spectrum antibiotics in 26.1%, and broad-spectrum antibiotics in 24.7%. A total of 1488 children (0.59%) were subsequently hospitalized and 117 (0.05%) developed severe pneumonia. Compared with children receiving narrow-spectrum antibiotics, the odds of subsequent hospitalization were higher in children receiving broad-spectrum antibiotics (aOR, 1.34; 95% CI, 1.17-1.52) and lower in children receiving macrolide monotherapy (aOR, 0.64; 95% CI, 0.55-0.73) and macrolides with narrow-spectrum antibiotics (aOR, 0.62; 95% CI, 0.39-0.97). Children receiving macrolide monotherapy had lower odds of developing severe pneumonia than children receiving narrow-spectrum antibiotics (aOR, 0.56; 95% CI, 0.33-0.93). However, the absolute risk difference was <0.5% for all analyses.
Macrolides are the most commonly prescribed antibiotic for ambulatory children with community-acquired pneumonia. Subsequent hospitalization and severe pneumonia are rare. Future efforts should focus on reducing broad-spectrum and macrolide antibiotic prescribing.
描述社区获得性肺炎门诊患儿的抗生素使用模式，并评估抗生素选择与临床结局之间的关系。
这是一项回顾性队列研究，纳入了 2010 年至 2016 年间接受医疗补助的 0-18 岁门诊社区获得性肺炎患儿，研究暴露为抗生素类别：窄谱（青霉素类）、广谱（阿莫西林/克拉维酸和头孢菌素类）、单一大环内酯类、大环内酯类联合窄谱抗生素或大环内酯类联合广谱抗生素。评估了抗生素选择与随后住院和发生严重肺炎（胸腔引流术、重症监护病房入院、机械通气）的结局之间的关系，并控制了疾病严重程度的措施。
在 252177 例门诊肺炎就诊中，43.2%的患儿使用单一大环内酯类，26.1%的患儿使用窄谱抗生素，24.7%的患儿使用广谱抗生素。共有 1488 例患儿（0.59%）随后住院，117 例（0.05%）发生严重肺炎。与使用窄谱抗生素的患儿相比，使用广谱抗生素的患儿随后住院的几率更高（比值比，1.34；95%可信区间，1.17-1.52），而使用单一大环内酯类（比值比，0.64；95%可信区间，0.55-0.73）和大环内酯类联合窄谱抗生素（比值比，0.62；95%可信区间，0.39-0.97）的患儿几率较低。使用单一大环内酯类的患儿发生严重肺炎的几率低于使用窄谱抗生素的患儿（比值比，0.56；95%可信区间，0.33-0.93）。然而，所有分析的绝对风险差异均<0.5%。
在门诊社区获得性肺炎患儿中，大环内酯类是最常被开的抗生素。随后住院和发生严重肺炎的情况较为罕见。未来的努力应重点减少广谱和大环内酯类抗生素的使用。
