July 8, 2015
Inappropriate Antibiotic Prescribing Reduced for
Pediatric CAP Inpatients

Nashville, TN—The effort paid off for hospitals that proactively disseminated 2011 national guidelines for appropriate use of antibiotics in children with community-acquired pneumonia (CAP), according to a new review.

A study published recently in the journal Pediatrics assessed the effect of the antibiotic prescribing guidelines, which recommended narrow-spectrum antibiotics for most children hospitalized with CAP, at three children’s hospitals.

Researchers from Vanderbilt University and colleagues focused on children hospitalized with clinical and radiographic-confirmed CAP from January 1, 2010, through June 30, 2012, at three hospitals in Tennessee and Utah as part of the national Centers for Disease Control and Prevention’s Etiology of Pneumonia in the Community study.

With antibiotic selection determined by the treating clinician, 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.

The guidelines recommend that ampicillin or penicillin G should be administered to fully immunized infants or school-aged children admitted to the hospital with CAP when local epidemiologic data documents the lack of substantial high-level penicillin resistance. Empiric therapy with a third-generation parenteral cephalosporin should be prescribed for patients who are not fully immunized, in regions with high penicillin resistance or if they have a life-threatening infection, the guidelines add.

During the preguideline period, 52.8% of the 2,121 children with CAP in the recent study received third-generation cephalosporins, with 2.7% receiving penicillin/ampicillin. By 9 months postguidelines, however, third-generation cephalosporin use declined by 12.4%, but penicillin/ampicillin use increased 11.3% .

Authors note that the most significant improvement was at hospitals that had implemented guideline-related dissemination activities.

“After publication of national guidelines, third-generation cephalosporin use declined and penicillin/ampicillin use increased among children hospitalized with CAP,” the study points out. “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.”

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