Children with suspected community-acquired pneumonia (CAP), who are administered antibiotics in the emergency department (ED) are more likely to receive antibiotics as inpatients, suggests a recent study published in the journal Pediatrics.¹

In this prospective cohort study, researchers set out to examine the clinical and demographic factors associated with inpatient antibiotic use in children who presented to the pediatric ED with suspected community-acquired pneumonia and were subsequently admitted to the hospital from 2013 to 2017. The median age was 2.8 years. A multivariable Poisson regression was performed and an interaction term was included to determine the impact of ED use of antibiotics on chest x-ray findings and inpatient antibiotic use. A subgroup analysis of children with nonradiographic pneumonia was also carried out. The primary outcomes were a minimum of one dose of inpatient antibiotics. The secondary outcome was administration of a full course of antibiotics.

Sixty percent of the 477 children included in the study were given ≥1 dose of antibiotics as inpatients and 53% received a full course of antibiotics. 80% patients received antibiotics in the ED went on to receive a full course.

After adjusting for confounders, children who were administered antibiotics in the ED were at 4-folds higher risk of receiving inpatient antibiotics with relative risk (RR) of 4.33. Fever (RR 1.66) and use of supplemental oxygen (RR 1.29) were the other factors associated with inpatient antibiotics.

Slightly over half (51%) of the study population had radiographic pneumonia or equivocal chest x-ray. The odds of receiving inpatient antibiotics was higher in these children versus those with normal chest x-rays, but the increased risk was modest when antibiotics were given in the ED. Similar factors influenced the administration of a full course of ED.

The study also found that 29% of 232 children with nonradiographic pneumonia were given inpatient antibiotics and 21% received a complete antibiotic course, even though they were at low risk for bacterial pneumonia. Those who received antibiotics in the ED were at 2.8 times higher risk of receiving antibiotics as inpatients.

The study demonstrates an association between clinical factors, chest x-ray findings and use of antibiotics in the ED. However, one-third of children with nonradiographic pneumonia were also given antibiotics highlighting the need for rational use of antibiotics. Since antibiotic administration in the ED strongly affected the decisions for inpatient antibiotic use, including full antibiotic course, indicative of “a modifiable target for future interventions”, note the authors. However, they also caution that since this was a single center study, the results may not be generalized. Also, interpretation of the chest x-ray is observed dependent.

Reference

1. Jillian M Cotter, et al. Factors associated with antibiotic use for children hospitalized with pneumonia. Pediatrics. 2022 Aug 1;150(2):e2021054677. doi: 10.1542/peds.2021-054677.