Community and Hospital-Acquired Pneumonia Both Addressed in New Studies on Antibiotic
DrLewisFirst, MD, MA, Editor in Chief, Pediatrics
It does not take lung, I mean long for a study on choosing the appropriate antibiotic
for presumptive bacterial pneumonia to get your attention and this week, we share
two such studies—one dealing with antibiotic selection in the setting of a community-acquired
pneumonia (CAP), and one focused on inpatient pneumonia.
The first of these studies by Handy et al. (10.1542/peds.2016-2331) compared guideline recommendations for amoxicillin being first-line for community-acquired
pneumonia with what is actually done within a large outpatient primary care network
involving more than 10,000 pediatric patients seen from 2009-2013. Sadly, only 40.7%
of patients got amoxicillin with 42% getting macrolides and 16.8% getting broad spectrum
antibiotics. Unfortunately, the factors that led to the use of an antimicrobial other
than amoxicillin involved factors unrelated to the underlying potential bacterial
pathogen. To find out what is driving variability in choice of antibiotic, read this
study in detail and see if some of those factors are influencing your choice as well
and what you might do differently as a result.
The second of these studies by Williams et al. (10.1542/peds.2016-3231) again compared a national evidence-based guideline with what actually is prescribed
at 28 children’s hospitals over a 6-year period (2009-2015) taking into account pre-
and post-choices around the guideline being implemented in 2011. In this case a guideline
made a difference with increased prescribing of penicillins (recommended as first
line for in-hospital pneumonia). Local efforts to implement the guideline on various
units seemed to make the most difference in who had the greatest increases in appropriate
use of penicillins.
The need to be a local champion to promote the dissemination of evidence-based guidelines
in both the in-and outpatient setting is easier said than done. To help guide us
in reducing the variability and increasing the adherence to guideline recommendations
for treatment of pneumonia, infectious disease specialists Drs. Adam Hersh and Matthew
Kronman offer a commentary on what we can do to prescribe more appropriate antibiotics
for CAP if such drugs are needed in our patients. The need to prescribe the right
antibiotic while being judicious with their use is an easy pill to swallow made easier
by reading both studies and commentary on this important topic.