Antibiotic Choice for Children Hospitalized With Pneumonia and Adherence to National Guidelines

作者：Williams, Derek J.^*; Edwards, Kathryn M.; Self, Wesley H.; Zhu, Yuwei; Ampofo, Krow; Pavia, Andrew T.; Hersh, Adam L.; Arnold, Sandra R.; McCullers, Jonathan A.; Hicks, Lauri A.; Bramley, Anna M.; Jain, Seema; Grijalva, Carlos G.

来源：Pediatrics, 2015, 136(1): 44-52.

DOI：10.1542/peds.2014-3047

• COMMUNITY-ACQUIRED PNEUMONIA
• INFECTIOUS-DISEASES-SOCIETY
• NONSUSCEPTIBLE STREPTOCOCCUS-PNEUMONIAE
• CLINICAL-PRACTICE GUIDELINES
• INTERRUPTED TIME-SERIES
• MANAGEMENT
• ETIOLOGY
• CARE

INTRODUCTION: The 2011 national guidelines for the management of childhood community-acquired pneumonia (CAP) recommended narrow-spectrum antibiotics (eg, ampicillin) for most children hospitalized with CAP. We assessed the impact of these guidelines on antibiotic prescribing at 3 children's hospitals.
METHODS: Children hospitalized with clinical and radiographic CAP were enrolled from January 1, 2010, through June 30, 2012, at 3 hospitals in Tennessee and Utah as part of the Centers for Disease Control and Prevention Etiology of Pneumonia in the Community study. Antibiotic selection was determined by the treating provider. The impact of the guidelines and hospital-level implementation efforts was determined by assessing the monthly percentage of enrolled children receiving third-generation cephalosporins or penicillin/ampicillin. Segmented linear regression was used to compare observed antibiotic selection in the postguideline period with expected antibiotic use projected from preguideline months.
RESULTS: Overall, 2121 children were included. During the preguideline period, 52.8% (interquartile range 47.8-56.6) of children with CAP received third-generation cephalosporins, whereas 2.7% (2.1, 7.0) received penicillin/ampicillin. By 9 months postguidelines, third-generation cephalosporin use declined (absolute difference -12.4% [95% confidence interval -19.8% to -5.1%]), whereas penicillin/ampicillin use increased (absolute difference 11.3% [4.3%-18.3%]). The most substantial changes were noted at those institutions that implemented guideline-related dissemination activities.
CONCLUSIONS: After publication of national guidelines, third-generation cephalosporin use declined and penicillin/ampicillin use increased among children hospitalized with CAP. Changes were more apparent among those institutions that proactively disseminated the guidelines, suggesting that targeted, hospital-based efforts are important for timely implementation of guideline recommendations.

• 出版日期2015-7