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Management guidelines increased use of ampicillin for CAP
Newman RE. Pediatrics. 2012;doi:10.1542/peds.2011-1533.
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Instituting clinical practice guidelines and antimicrobial stewardship programs led to an increase in use of ampicillin for children hospitalized with community-acquired pneumonia, according to study results recently published online.
To evaluate the effectiveness of clinical practice guidelines and antimicrobial stewardship programs on hospitalized patients with community-acquired pneumonia (CAP), researchers conducted a retrospective study of discharged patients from a children’s hospital with an ICD-9 code for pneumonia. Eligible patients were selected from those hospitalized from 2007 to 2009, 12 months before and after CAP clinical practice guidelines were introduced. The target of this review was antibiotic utilization based on provider diagnosis of pneumonia, rather than the accuracy of diagnosis.
Exclusion criteria for this study consisted of:
- Aged younger than 2 months.
- Prematurity of less than 36 weeks’ gestation.
- Diagnosed with pneumonia 3 days after admission.
- Immunocompromised.
- One of the following: congenital heart disease, chronic lung disease (except asthma), sickle cell disease, neurologic condition or neuromuscular disorder.
- Admitted with an effusion on chest radiograph requiring a diagnostic or therapeutic procedure.
One thousand thirty-three patients were incorporated in the final analysis, including 530 patients admitted before clinical practice guidelines were instituted and 503 patients admitted after they were instituted. Researchers observed that 13% of children admitted before clinical practice guidelines received ampicillin and 72% of children received ceftriaxone. However, in children admitted in the year after the introduction of clinical practice guidelines, 63% received ampicillin and 21% received ceftriaxone.
Analysis revealed that the antimicrobial stewardship program (P=.002) and clinical practice guidelines (P<.001) were linked to significant increases in ampicillin use and a decrease in ceftriaxone (P<.001). In addition, the antimicrobial stewardship program was associated with a 20% increase in ampicillin use, whereas the inclusion of clinical practice guidelines was associated with an additional combined increase of 34%.
“We showed that these interventions can increase the empirical use of ampicillin as well as amoxicillin for otherwise healthy hospitalized children with uncomplicated CAP without an increase in negative consequences,” the researchers said. “Because CAP is a common pediatric condition, the use of a narrow-spectrum agent is important in preventing the further development of antibiotic resistance.”
Disclosure:
- The researchers report no relevant financial disclosures.