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Ampicillin, amoxicillin prescriptions increased after CAP guideline publication
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After the 2011 Pediatric Infectious Diseases Society and Infectious Diseases Society of America guidelines that recommended ampicillin or amoxicillin for children hospitalized with community-acquired pneumonia, prescriptions for these drugs increased but still remain low, according to recent study findings published in Clinical Infectious Diseases.
“Eighteen months after guideline release, however, the majority of patients still did not receive ampicillin or amoxicillin,” the researchers wrote. “Use of cephalosporins and macrolides remained substantial though was decreasing significantly.”
Jeffrey S. Gerber, MD, PhD, of The Children’s Hospital of Philadelphia, and colleagues examined 38,819 children aged 6 months to 18 years with community-acquired pneumonia (CAP) to determine the use of ampicillin or amoxicillin after guideline publication.
Twenty-eight percent of patients received ampicillin or amoxicillin during the 42-month study period. Less than 0.1% received penicillin. Seventy-eight percent of patients received ampicillin or amoxicillin on the first day of antibiotic therapy and 47% did not receive any other antibiotic treatment during admission. Eighteen months after guideline publication, there was a 43% increase in ampicillin and amoxicillin prescriptions.
Sixty-six percent of patients received cephalosporins; however, the prescriptions decreased during the study period (P<.001). Thirty-two percent of patients received macrolides, and those prescriptions decreased after guideline publication (P=.003).
“Recommended first-line antibiotic therapy for children hospitalized with CAP has increased following publication of PIDS/IDSA treatment guidelines, but overall use remains low,” the researchers wrote. “Cephalosporin and macrolide prescribing is decreasing but remains common. Guideline adoption was not consistent across institutions. Further studies exploring the outcomes of and reasons for compliance with treatment guidelines are warranted.”
Disclosure: Three researchers report financial ties with Pfizer. One researcher reports financial ties with Astellas Pharma, Cubist, Merck and Pfizer.
Perspective
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Todd A. Florin, MD, MSCE
The results of the study by Gerber and colleagues are both optimistic and pessimistic in nature. Current evidence and the Infectious Diseases Society of America/Pediatric Infectious Diseases Society guidelines suggest that narrow-spectrum antibiotics active against Streptococcus pneumoniae, including ampicillin and amoxicillin, are not superior to broader-spectrum cephalosporins in the treatment of non-severe community-acquired pneumonia.
It is fantastic to see use of recommended first-line therapy of amoxicillin or ampicillin increasing since guideline publication. This is essential in providing effective antibiotics while also minimizing the development of antimicrobial resistance. It is more disconcerting to see that rates of cephalosporin use have not decreased significantly since guideline publication and that substantial variation across hospitals still exists in the adoption of the Infectious Diseases Society of America/Pediatric Infectious Diseases Society guidelines. These findings, in addition to a growing literature that suggests that the development of local clinical practice guidelines decreases unwarranted variation within institutions, call for improved tools for disseminating and implementing evidence-based recommendations at individual institutions. The responsibility for such improvement falls on individual hospitals and providers to be aware of national guidelines and put such evidence-based practices into place.
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