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Impact of a Guideline on Management of Children Hospitalized With Community-Acquired Pneumonia

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Impact of a Guideline on Management of Children Hospitalized With Community-Acquired Pneumonia

  1. Ross E. Newman, DOa,
  2. Erin B. Hedican, MPHb,
  3. Joshua C. Herigon, MPHb,
  4. David D. Williams, MPHc,
  5. Arthur R. Williams, PhD, MA, MPAd, and
  6. Jason G. Newland, MDb

Author Affiliations


  1. Sections of aGeneral Pediatrics and

  2. bInfectious Diseases, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Children’s Mercy Hospitals and Clinics, Kansas City, Missouri;

  3. cCenter for Clinical Effectiveness, Quality Improvement, Children’s Mercy Hospitals and Clinics, Kansas City, Missouri; and

  4. dDepartment of Health Policy and Management, College of Public Health, University of South Florida, Tampa, Florida

Abstract

OBJECTIVES: We sought to describe the impact a clinical practice guideline (CPG) had on antibiotic management of children hospitalized with community-acquired pneumonia (CAP).

PATIENTS AND METHODS: We conducted a retrospective study of discharged patients from a children’s hospital with an ICD-9-CM code for pneumonia (480–486). Eligible patients were admitted from July 8, 2007, through July 9, 2009, 12 months before and after the CAP CPG was introduced. Three-stage least squares regression analyses were performed to examine hypothesized simultaneous relationships, including the impact of our institution\x{2019}s antimicrobial stewardship program (ASP).

RESULTS: The final analysis included 1033 patients: 530 (51%) before the CPG (pre-CPG) and 503 (49%) after the CPG (post-CPG). Pre-CPG, ceftriaxone (72%) was the most commonly prescribed antibiotic, followed by ampicillin (13%). Post-CPG, the most common antibiotic was ampicillin (63%). The effect of the CPG was associated with a 34% increase in ampicillin use (P < .001). Discharge antibiotics also changed post-CPG, showing a significant increase in amoxicillin use (P < .001) and a significant decrease in cefdinir and amoxicillin/clavulanate (P < .001), with the combined effect of the CPG and ASP leading to 12% (P < 0.001) and 16% (P < .001) reduction, respectively. Overall, treatment failure was infrequent (1.5% vs 1%).

CONCLUSIONS: A CPG and ASP led to the increase in use of ampicillin for children hospitalized with CAP. In addition, less broad-spectrum discharge antibiotics were used. Patient adverse outcomes were low, indicating that ampicillin is appropriate first-line therapy for otherwise healthy children admitted with uncomplicated CAP.

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