Treatment failure uncommon among children who do not receive antibiotics for pneumonia
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Key takeaways:
- More than 20% of children diagnosed with pneumonia did not receive antibiotics.
- Treatment failure was slightly more common in children who did not receive antibiotics vs. those who did (10.7 % vs. 8.7%).
Most children who did not receive antibiotics for pneumonia did not experience treatment failure or severe outcomes, according to study findings published in JAMA Network Open.
“Guidelines from the Infectious Diseases Society of America recommend that preschool-aged children with pneumonia who are well enough to be treated in an outpatient setting do not routinely require antibiotic treatment,” Daniel J. Shapiro, MD, MPH, assistant professor of emergency medicine at University of California, San Francisco School of Medicine and pediatric emergency care physician at UCSF Benioff Children’s Hospital, and colleagues wrote. “However, in practice, antibiotics are prescribed for most children, likely because of concerns about bacterial coinfection and lack of published evidence to guide a decision not to prescribe antibiotics.”
Several studies have found that a short course of antibiotics is comparable to a long course for the treatment of community-acquired pneumonia in children, but there are few data available about children who receive no antibiotic treatment for pneumonia, according to Shapiro and colleagues.
The researchers conducted a retrospective cohort study of 103,854 children (52.6% boys; median age, 5 years; interquartile range, 2 to 9 years) who were diagnosed with pneumonia in ambulatory care settings between Jan. 1, 2017, and Dec. 31, 2019. They compared the rate of treatment failure within 14 days of diagnosis based on whether the patients filled an antibiotic prescription within 2 days of their initial visit. The researchers used the Merative MarketScan Medicaid database to confirm whether children received antibiotics.
Overall, 80.3% of patients received antibiotics. Non-Hispanic Black children were less likely to receive antibiotics than non-Hispanic white or Hispanic children (79% vs. 81.7% and 82.6%; P < .001), and children who visited EDs were less likely to fill an antibiotic prescription compared with those who went to urgent care centers or outpatient clinics (74.4% vs. 88.7% and 82.7%; P < .001).
In the unadjusted analysis, 10.8% of children who did not receive antibiotics experienced treatment failure, and 1.1% experienced a severe outcome, which was a slightly larger proportion compared with children who did receive antibiotics (8.2% and 0.5% respectively).
The researchers also conducted an adjusted analysis with 20,277 patients in each group, which identified a similar trend. Among children who did not receive antibiotics, 10.7% experienced treatment failure vs. 8.7% of children who received antibiotics (risk difference = 1.98 percentage points; 95% CI, 1.41-2.56). Severe outcomes occurred among 1.1% of children who did not receive antibiotics and 0.7% of children who did (risk difference = 0.46 percentage points; 95% CI, 0.28-0.64).
“The risks of treatment failure in those who did not vs. did receive antibiotics were reduced after excluding children with asthma or bronchiolitis (9.9% vs. 9%) and after lengthening the exposure window (7.3% vs. 7.1%), which suggests that some of the differences in outcomes may be explained by comorbid lower respiratory tract illnesses, the specific definition of the exposure window or misclassification of the diagnosis of pneumonia,” Shapiro and colleagues wrote. “Together, these results suggest that most children do not experience treatment failure or severe outcomes if they do not receive antibiotics.”
The researchers said future research should attempt to identify which children do not need antibiotic treatment for pneumonia.
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