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Outpatient CAP rates remain stable, despite vaccination
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The rate of children who were hospitalized for community-acquired pneumonia did not change significantly between the 1990s and during the past decade, despite introduction of the heptavalent pneumococcal conjugate vaccine in 2000, according to research from the National Ambulatory and National Hospital Ambulatory Medical Care Surveys.
The surveys also revealed that macrolides were frequently prescribed despite evidence that they provide little benefit over penicillins.
Matthew P. Kronman, MD, of the division of infectious diseases and division of general pediatrics, The Children’s Hospital of Philadelphia, and colleagues used the surveys to identify children with community-acquired pneumonia (CAP). They looked at outpatient CAP rates and data surrounding broad-spectrum antibiotic use to treat the patients.
CAP visit rates ranged from 16.9 to 22.4 per 1,000 population, with the highest rates occurring in children younger than 5 years, with no variation after 2000, despite routine use of the 7-valent pneumococcal conjugate vaccine (Prevnar, Wyeth). The researchers said the vaccine may be preventing more serious cases of Streptococcus pneumoniae, but not some of the milder cases. This may explain another trend noted in the findings; notably, that from 2000 to 2007, there was about an 8% decrease in emergency visits, but a corresponding 8% increase in office visits related to S. pneumonia.
Physicians commonly prescribed broad-spectrum antibiotics, including macrolides and cephalosporins. Penicillins were prescribed less frequently, about 14%, compared with the other antibiotics. The researchers said cephalosporin use increased significantly in the years after vaccine introduction. Increasing age, a visit to a nonemergency department office, and obtaining a radiograph or complete blood count were all predictive of broad-spectrum antibiotic prescribing.
The researchers said there were some limitations, including that the survey data did not include information on allergies or physical exam findings. Also, some of the cases may have been viral infections, not CAP.
For more information:
- Kronman MP. Pediatrics. 2011;doi:10.1542/peds.2010-2008.
Disclosure: The researchers reported no relevant financial disclosures.