Use of broad-spectrum antibiotics to treat pediatric pneumonia dropped considerably following the publication of national guidelines that recommended narrow-spectrum antibiotics, according to a recent study.
The guidelines released by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA) in August 2011 “emphasized the use of a single, narrow-spectrum antibiotic (i.e., penicillin/ampicillin) for vaccinated children hospitalized with uncomplicated community-acquired pneumonia,” based on evidence that Streptococcus pneumoniae most commonly caused the illness and that incidence of penicillin-resistant pneumococcal disease had dropped after the vaccine’s introduction.
“Overall, use of third-generation cephalosporins declined significantly after release of the guidelines, whereas penicillin/ampicillin use increased,” reported Dr. Derek Williams of Monroe Carell Jr. Children’s Hospital and Vanderbilt University in Nashville, Tenn., and his associates. “We noted consistent trends across study sites, although changes were most apparent in institutions that conducted active hospital-based educational efforts to disseminate the PIDS/IDSA guidelines,” they wrote (Pediatrics 2015 June 22 [doi:10.1542/peds.2014-3047]).
The researchers analyzed the records of all 2,121 children hospitalized with community-acquired pneumonia between January 2010 and June 2012 at three hospitals in Tennessee and Utah. In the year before the new guidelines, all three hospitals most commonly used the broad-spectrum antibiotics, with prescription rates ranging from 43% to 61% for third-generation cephalosporins, compared with rates of 1%-9% for penicillin and ampicillin prescriptions. Overall, 52.8% of children received third-generation cephalosporins to treat their pneumonia and 2.7% received penicillin or ampicillin before the guidelines.
Nine months after the guidelines had been published, the use of third-generation cephalosporins dropped 12.4 percentage points and the use of penicillin and ampicillin increased 11.3 percentage points, Dr. Williams and his associates said.
The largest shift in prescribing patterns occurred at the two hospitals that held pediatric departmental educational conferences within 4 months of the new guidelines. The third hospital, which did not formally distribute information abut the guidelines, saw the smallest reduction in broad spectrum–antibiotic use.
Although all three hospitals reported having antimicrobial stewardship programs, none had a community-acquired pneumonia practice guideline during the study period and none of the programs specifically focused on community-acquired pneumonia or restrictions on third-generation cephalosporins, aminopenicillins, or macrolides.
The research was supported by the National Institute of Allergy and Infectious Diseases, the Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention. The authors reported no relevant financial disclosures.