Division of Pediatric Emergency Medicine, University of California, San Francisco.
Children's Hospital Association, Lenexa, Kansas.
JAMA Netw Open. 2024 Oct 1;7(10):e2441821. doi: 10.1001/jamanetworkopen.2024.41821.
Although a viral etiology can be detected in most cases of pediatric pneumonia, antibiotic treatment is common. The effectiveness of antibiotics in the outpatient setting for children diagnosed with pneumonia is not known.
To compare outcomes among children diagnosed with pneumonia who were and were not treated with oral antibiotics.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study identified Medicaid-insured children and adolescents 17 years or younger diagnosed with pneumonia and discharged from ambulatory settings in a multistate claims database from January 1, 2017, to December 31, 2019. Propensity score matching was used to mitigate confounding. Data were analyzed from August 31, 2023, to August 16, 2024.
Antibiotic receipt, defined as an oral antibiotic dispensed from a pharmacy on the day of the index visit or on the subsequent day. Children who did not receive antibiotics included those who were not prescribed antibiotics and those who were prescribed antibiotics but did not fill the prescription.
Treatment failure and severe outcomes within 2 to 14 days after the index visit. Treatment failure included hospitalization or ambulatory revisits for pneumonia, new antibiotic dispensation with a same-day ambulatory visit, or complicated pneumonia. Severe outcomes included hospitalization for pneumonia or complicated pneumonia.
Among the 103 854 children with pneumonia included in the analysis, the median age was 5 (IQR, 2-9) years, and 54 665 (52.6%) were male. Overall, 20 435 children (19.7%) did not receive an antibiotic within 1 day. The propensity score-matched analysis included 40 454 children (20 227 per group). Treatment failure occurred in 2167 children (10.7%) who did not receive antibiotics and 1766 (8.7%) who received antibiotics (risk difference, 1.98 [95% CI, 1.41-2.56] percentage points). Severe outcomes occurred in 234 of 20 435 children (1.1%) who did not receive antibiotics and in 133 of 83 419 (0.7%) who did (risk difference, 0.46 [95% CI, 0.28-0.64] percentage points).
In this cohort study of children diagnosed with pneumonia in ambulatory settings, almost 20% did not receive antibiotics within a day of diagnosis. Although not receiving antibiotics was associated with a small increase in the risk of treatment failure, severe outcomes were uncommon regardless of whether antibiotics were received. These results suggest that some children diagnosed with pneumonia can likely be managed without antibiotics and highlight the need for prospective studies to identify these children.
尽管大多数小儿肺炎病例都能检测到病毒病因，但抗生素治疗仍很常见。在门诊环境下，对于诊断为肺炎的儿童，抗生素治疗的效果尚不清楚。
比较接受和未接受口服抗生素治疗的肺炎患儿的结局。
设计、地点和参与者：这项回顾性队列研究从 2017 年 1 月 1 日至 2019 年 12 月 31 日，从一个多州索赔数据库中确定了医疗保险参保的 17 岁及以下儿童和青少年，这些患者被诊断为肺炎并从门诊环境出院。使用倾向评分匹配来减轻混杂因素。数据分析于 2023 年 8 月 31 日至 2024 年 8 月 16 日进行。
抗生素的使用，定义为在就诊当天或次日从药房开出的口服抗生素。未接受抗生素治疗的患儿包括未开抗生素处方和开了抗生素但未开药的患儿。
就诊后 2 至 14 天内的治疗失败和严重结局。治疗失败包括因肺炎住院或门诊复诊、同日因肺炎再次就诊时新开抗生素处方、或出现复杂性肺炎。严重结局包括因肺炎或复杂性肺炎住院。
在分析中纳入的 103854 例肺炎患儿中，中位年龄为 5 岁（IQR，2 岁至 9 岁），54665 例（52.6%）为男性。总体而言，有 20435 例（19.7%）患儿在 1 天内未接受抗生素治疗。在匹配后的倾向评分分析中，纳入了 40454 例患儿（每组 20227 例）。未接受抗生素治疗的患儿中有 2167 例（10.7%）发生治疗失败，接受抗生素治疗的患儿中有 1766 例（8.7%）发生治疗失败（风险差异，1.98 [95% CI，1.41-2.56]个百分点）。未接受抗生素治疗的患儿中有 234 例（1.1%）发生严重结局，接受抗生素治疗的患儿中有 133 例（0.7%）发生严重结局（风险差异，0.46 [95% CI，0.28-0.64]个百分点）。
在这项针对门诊环境下诊断为肺炎的患儿的队列研究中，近 20%的患儿在诊断后 1 天内未接受抗生素治疗。尽管未接受抗生素治疗与治疗失败风险略有增加相关，但严重结局并不常见，无论是否使用抗生素。这些结果表明，一些诊断为肺炎的儿童可能无需使用抗生素即可得到治疗，这突出表明需要开展前瞻性研究来确定这些患儿。
