Children with community-acquired pneumonia (CAP) often aren’t getting the type of antibiotics recommended by infectious disease experts and the Academy, a new study found.
Instead of amoxicillin, some physicians are prescribing macrolides and broad-spectrum antibiotics, according to the study “Variability in Antibiotic Prescribing for Community-Acquired Pneumonia” (Handy LK, et al. Pediatrics. March 7, 2017, https://doi.org/10.1542/peds.2016-2331). It was one of two studies released in Pediatrics this week on prescribing for pneumonia.
Each year, primary care providers diagnose about 1.2 million children in the U.S. with CAP. In 2011, the Pediatric Infectious Diseases Society and Infectious Diseases Society of America released guidelines for management of CAP that have been endorsed by the Academy. The groups recommend amoxicillin for most children with CAP in outpatient settings.
However, researchers analyzed data from 10,414 children diagnosed with CAP by a primary care provider from July 1, 2009, to June 30, 2013, and found 40.7% received amoxicillin, 42.5% received macrolides and 16.8% received broad-spectrum antibiotics. The broad-spectrum antibiotics consisted largely of amoxicillin-clavulanic acid.
The findings come despite macrolides being recommended only for atypical pneumonia in older children and broad-spectrum antibiotics being linked to adverse events and antibiotic resistance, according to the study.
Children were more likely to receive macrolides than amoxicillin if they were 5 years or older, had private insurance, or had a history of asthma or prior antibiotic exposure. Those more likely to receive broad-spectrum antibiotics than amoxicillin were seen at suburban practices or had prior antibiotic exposure.
“Although age and prior antibiotic use were appropriate drivers of prescribing patterns, sociodemographic factors including insurance status and practice location that should not be correlated with bacterial etiology were also associated with antibiotic choice,” authors wrote.
They called for additional education and tools to help providers choose the correct treatment.
The authors of a related commentary (Hersh AL, Kronman MP. Pediatrics. March 7, 2017, https://doi.org/10.1542/peds.2017-0027) echoed that call and stressed the need for careful prescribing to prevent antibiotic resistance.
“The work of Handy et al. highlights the fact that both clinical and non-clinical factors may contribute to inappropriate prescribing and that all domains of inappropriate antibiotic use must be targeted in order to achieve our national goals for reducing inappropriate use,” they wrote.
Hospital settings
A separate study (Williams DJ, et al. Pediatrics. March 8, 2017, https://doi.org/10.1542/peds.2016-3231) also found variability in antibiotic prescribing for CAP at children’s hospitals but noted improvements.
Researchers analyzed data on 28 hospitals from the Pediatric Health Information Database from August 2009 to March 2015. They found penicillin prescribing was less than 10% before the 2011 guidelines and rose by 27.6% by March 2015. During that period, use of cephalosporin, a broad-spectrum antibiotic, declined by about the same percentage.
“Local implementation efforts may have enhanced guideline adoption and appeared more relevant than hospitals’ organizational readiness to change,” authors wrote.
