December 18, 2013
Narrowly Focused Antibiotics Equally Effective for
Pediatric Pneumonia

Nashville, TN—Narrowly focused antibiotics such as penicillin or ampicillin work just as well for treating pneumonia in pediatric inpatients as broad-spectrum agents such as ceftriaxone or cefotaxime, according to a new study.

Vanderbilt University researchers note that outcomes are similar—including length of stay and costs—with both types of antibiotics. Results were published recently in the journal Pediatrics.

Broad-spectrum antibiotics are frequently overprescribed for pneumonia, which is one of the most common reasons for hospitalization among U.S. children, according to background in the article. Both types of antibiotics are considered effective against Streptococcus pneumoniae, the most common bacterial cause of pneumonia, but narrow spectrum is recommended to help stem growing resistance to the drug class.

“Sometimes there is a perception, not restricted to pneumonia, that the use of a broad spectrum antibiotic, a big gun, is going to be the best treatment for all patients. This perception can complicate the selection of antibiotics especially when there is limited information to support the decision,” said senior author Carlos G. Grijalva, MD, MPH. “To help inform those decisions, this study compared two pneumonia treatment regimens, a big gun (broad spectrum antibiotics) vs. a small gun (narrow spectrum antibiotics), and found there were no significant differences in clinical outcomes or associated costs.”

Narrow spectrum antibiotic therapy for pediatric pneumonia was recommended more than 2 years ago by a joint guideline from the Pediatric Infectious Diseases Society and Infectious Diseases Society of America, but this is one of the first studies to compare the effectiveness of that regimen with the use of broad-spectrum antibiotics.

For the study, researchers reviewed data from 43 pediatric hospitals in the U.S., comparing outcomes among children 6 months to 18 years of age hospitalized for pneumonia between 2005 and 2011.

In the cases reviewed, 13,954 children received broad-spectrum therapy, 89.7%, and 1,610 received narrow-spectrum therapy, 10.3%, in a 3-day median hospital stay.

Of the children receiving broad-spectrum therapy, 1,506 were admitted to intensive care compared to 13 given narrow-spectrum therapy. Readmission rates were similar with 2.3% of the broad-spectrum patients coming back to the hospital, compared to 2.4% of children receiving narrow-spectrum therapy.

“We have seen increases in use of broad spectrum antibiotics and concurrent increases in disease caused by resistant bacteria. For this study, we hypothesized that narrow and broad-spectrum antibiotics would have similar effectiveness in the treatment of childhood pneumonia. Our findings support the preferential use of narrow spectrum antibiotics as first-line therapies for most children hospitalized with pneumonia,” said lead author Derek J. Williams, MD, MPH.

Williams pointed out that nearly 90% of children in the study had received broad-spectrum therapy, compared with only 10% receiving narrow-spectrum therapy.

“Although ampicillin or penicillin therapy was as effective as the third generation cephalosporins, use of the narrower spectrum drugs was very uncommon prior to release of the guidelines. In the near future, it would be interesting to evaluate whether the release of the consensus guidelines and related efforts facilitate widespread adoption of the new treatment recommendations,” he added.

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