Antibiotic choice for children hospitalized with pneumonia and adherence to national guidelines

Derek J. Williams, Kathryn M. Edwards, Wesley H. Self, Yuwei Zhu, Krow Ampofo, Andrew T. Pavia, Adam L. Hersh, Sandra Arnold, Jonathan Mccullers, Lauri A. Hicks, Anna M. Bramley, Seema Jain, Carlos G. Grijalva

Research output: Contribution to journalReview article

14 Citations (Scopus)

Abstract

INTRODUCTION: The 2011 national guidelines for the management of childhood community-acquired pneumonia (CAP) recommended narrow-spectrum antibiotics (eg, ampicillin) for most children hospitalized with CAP. We assessed the impact of these guidelines on antibiotic prescribing at 3 children's hospitals. METHODS: Children hospitalized with clinical and radiographic CAP were enrolled from January 1, 2010, through June 30, 2012, at 3 hospitals in Tennessee and Utah as part of the Centers for Disease Control and Prevention Etiology of Pneumonia in the Community study. Antibiotic selection was determined by the treating provider. The impact of the guidelines and hospital-level implementation efforts was determined by assessing the monthly percentage of enrolled children receiving third-generation cephalosporins or penicillin/ampicillin. Segmented linear regression was used to compare observed antibiotic selection in the postguideline period with expected antibiotic use projected from preguideline months. RESULTS: Overall, 2121 children were included. During the preguideline period, 52.8% (interquartile range 47.8-56.6) of children with CAP received third-generation cephalosporins, whereas 2.7% (2.1, 7.0) received penicillin/ampicillin. By 9 months postguidelines, third-generation cephalosporin use declined (absolute difference 212.4% [95% confidence interval 219.8% to 25.1%]), whereas penicillin/ampicillin use increased (absolute difference 11.3% [4.3%-18.3%]). The most substantial changes were noted at those institutions that implemented guideline-related dissemination activities. CONCLUSIONS: After publication of national guidelines, third-generation cephalosporin use declined and penicillin/ampicillin use increased among children hospitalized with CAP. Changes were more apparent among those institutions that proactively disseminated the guidelines, suggesting that targeted, hospital-based efforts are important for timely implementation of guideline recommendations.

Original languageEnglish (US)
Pages (from-to)44-52
Number of pages9
JournalPediatrics
Volume136
Issue number1
DOIs
StatePublished - Jul 1 2015

Fingerprint

Hospitalized Child
Pneumonia
Ampicillin
Guidelines
Anti-Bacterial Agents
Cephalosporins
Penicillins
Centers for Disease Control and Prevention (U.S.)
Publications
Linear Models
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

Williams, D. J., Edwards, K. M., Self, W. H., Zhu, Y., Ampofo, K., Pavia, A. T., ... Grijalva, C. G. (2015). Antibiotic choice for children hospitalized with pneumonia and adherence to national guidelines. Pediatrics, 136(1), 44-52. https://doi.org/10.1542/peds.2014-3047

Antibiotic choice for children hospitalized with pneumonia and adherence to national guidelines. / Williams, Derek J.; Edwards, Kathryn M.; Self, Wesley H.; Zhu, Yuwei; Ampofo, Krow; Pavia, Andrew T.; Hersh, Adam L.; Arnold, Sandra; Mccullers, Jonathan; Hicks, Lauri A.; Bramley, Anna M.; Jain, Seema; Grijalva, Carlos G.

In: Pediatrics, Vol. 136, No. 1, 01.07.2015, p. 44-52.

Research output: Contribution to journalReview article

Williams, DJ, Edwards, KM, Self, WH, Zhu, Y, Ampofo, K, Pavia, AT, Hersh, AL, Arnold, S, Mccullers, J, Hicks, LA, Bramley, AM, Jain, S & Grijalva, CG 2015, 'Antibiotic choice for children hospitalized with pneumonia and adherence to national guidelines', Pediatrics, vol. 136, no. 1, pp. 44-52. https://doi.org/10.1542/peds.2014-3047
Williams DJ, Edwards KM, Self WH, Zhu Y, Ampofo K, Pavia AT et al. Antibiotic choice for children hospitalized with pneumonia and adherence to national guidelines. Pediatrics. 2015 Jul 1;136(1):44-52. https://doi.org/10.1542/peds.2014-3047
Williams, Derek J. ; Edwards, Kathryn M. ; Self, Wesley H. ; Zhu, Yuwei ; Ampofo, Krow ; Pavia, Andrew T. ; Hersh, Adam L. ; Arnold, Sandra ; Mccullers, Jonathan ; Hicks, Lauri A. ; Bramley, Anna M. ; Jain, Seema ; Grijalva, Carlos G. / Antibiotic choice for children hospitalized with pneumonia and adherence to national guidelines. In: Pediatrics. 2015 ; Vol. 136, No. 1. pp. 44-52.
@article{5b7823391b3f4c2f87a7b61579107add,
title = "Antibiotic choice for children hospitalized with pneumonia and adherence to national guidelines",
abstract = "INTRODUCTION: The 2011 national guidelines for the management of childhood community-acquired pneumonia (CAP) recommended narrow-spectrum antibiotics (eg, ampicillin) for most children hospitalized with CAP. We assessed the impact of these guidelines on antibiotic prescribing at 3 children's hospitals. METHODS: Children hospitalized with clinical and radiographic CAP were enrolled from January 1, 2010, through June 30, 2012, at 3 hospitals in Tennessee and Utah as part of the Centers for Disease Control and Prevention Etiology of Pneumonia in the Community study. Antibiotic selection was determined by the treating provider. The impact of the guidelines and hospital-level implementation efforts was determined by assessing the monthly percentage of enrolled children receiving third-generation cephalosporins or penicillin/ampicillin. Segmented linear regression was used to compare observed antibiotic selection in the postguideline period with expected antibiotic use projected from preguideline months. RESULTS: Overall, 2121 children were included. During the preguideline period, 52.8{\%} (interquartile range 47.8-56.6) of children with CAP received third-generation cephalosporins, whereas 2.7{\%} (2.1, 7.0) received penicillin/ampicillin. By 9 months postguidelines, third-generation cephalosporin use declined (absolute difference 212.4{\%} [95{\%} confidence interval 219.8{\%} to 25.1{\%}]), whereas penicillin/ampicillin use increased (absolute difference 11.3{\%} [4.3{\%}-18.3{\%}]). The most substantial changes were noted at those institutions that implemented guideline-related dissemination activities. CONCLUSIONS: After publication of national guidelines, third-generation cephalosporin use declined and penicillin/ampicillin use increased among children hospitalized with CAP. Changes were more apparent among those institutions that proactively disseminated the guidelines, suggesting that targeted, hospital-based efforts are important for timely implementation of guideline recommendations.",
author = "Williams, {Derek J.} and Edwards, {Kathryn M.} and Self, {Wesley H.} and Yuwei Zhu and Krow Ampofo and Pavia, {Andrew T.} and Hersh, {Adam L.} and Sandra Arnold and Jonathan Mccullers and Hicks, {Lauri A.} and Bramley, {Anna M.} and Seema Jain and Grijalva, {Carlos G.}",
year = "2015",
month = "7",
day = "1",
doi = "10.1542/peds.2014-3047",
language = "English (US)",
volume = "136",
pages = "44--52",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "1",

}

TY - JOUR

T1 - Antibiotic choice for children hospitalized with pneumonia and adherence to national guidelines

AU - Williams, Derek J.

AU - Edwards, Kathryn M.

AU - Self, Wesley H.

AU - Zhu, Yuwei

AU - Ampofo, Krow

AU - Pavia, Andrew T.

AU - Hersh, Adam L.

AU - Arnold, Sandra

AU - Mccullers, Jonathan

AU - Hicks, Lauri A.

AU - Bramley, Anna M.

AU - Jain, Seema

AU - Grijalva, Carlos G.

PY - 2015/7/1

Y1 - 2015/7/1

N2 - INTRODUCTION: The 2011 national guidelines for the management of childhood community-acquired pneumonia (CAP) recommended narrow-spectrum antibiotics (eg, ampicillin) for most children hospitalized with CAP. We assessed the impact of these guidelines on antibiotic prescribing at 3 children's hospitals. METHODS: Children hospitalized with clinical and radiographic CAP were enrolled from January 1, 2010, through June 30, 2012, at 3 hospitals in Tennessee and Utah as part of the Centers for Disease Control and Prevention Etiology of Pneumonia in the Community study. Antibiotic selection was determined by the treating provider. The impact of the guidelines and hospital-level implementation efforts was determined by assessing the monthly percentage of enrolled children receiving third-generation cephalosporins or penicillin/ampicillin. Segmented linear regression was used to compare observed antibiotic selection in the postguideline period with expected antibiotic use projected from preguideline months. RESULTS: Overall, 2121 children were included. During the preguideline period, 52.8% (interquartile range 47.8-56.6) of children with CAP received third-generation cephalosporins, whereas 2.7% (2.1, 7.0) received penicillin/ampicillin. By 9 months postguidelines, third-generation cephalosporin use declined (absolute difference 212.4% [95% confidence interval 219.8% to 25.1%]), whereas penicillin/ampicillin use increased (absolute difference 11.3% [4.3%-18.3%]). The most substantial changes were noted at those institutions that implemented guideline-related dissemination activities. CONCLUSIONS: After publication of national guidelines, third-generation cephalosporin use declined and penicillin/ampicillin use increased among children hospitalized with CAP. Changes were more apparent among those institutions that proactively disseminated the guidelines, suggesting that targeted, hospital-based efforts are important for timely implementation of guideline recommendations.

AB - INTRODUCTION: The 2011 national guidelines for the management of childhood community-acquired pneumonia (CAP) recommended narrow-spectrum antibiotics (eg, ampicillin) for most children hospitalized with CAP. We assessed the impact of these guidelines on antibiotic prescribing at 3 children's hospitals. METHODS: Children hospitalized with clinical and radiographic CAP were enrolled from January 1, 2010, through June 30, 2012, at 3 hospitals in Tennessee and Utah as part of the Centers for Disease Control and Prevention Etiology of Pneumonia in the Community study. Antibiotic selection was determined by the treating provider. The impact of the guidelines and hospital-level implementation efforts was determined by assessing the monthly percentage of enrolled children receiving third-generation cephalosporins or penicillin/ampicillin. Segmented linear regression was used to compare observed antibiotic selection in the postguideline period with expected antibiotic use projected from preguideline months. RESULTS: Overall, 2121 children were included. During the preguideline period, 52.8% (interquartile range 47.8-56.6) of children with CAP received third-generation cephalosporins, whereas 2.7% (2.1, 7.0) received penicillin/ampicillin. By 9 months postguidelines, third-generation cephalosporin use declined (absolute difference 212.4% [95% confidence interval 219.8% to 25.1%]), whereas penicillin/ampicillin use increased (absolute difference 11.3% [4.3%-18.3%]). The most substantial changes were noted at those institutions that implemented guideline-related dissemination activities. CONCLUSIONS: After publication of national guidelines, third-generation cephalosporin use declined and penicillin/ampicillin use increased among children hospitalized with CAP. Changes were more apparent among those institutions that proactively disseminated the guidelines, suggesting that targeted, hospital-based efforts are important for timely implementation of guideline recommendations.

UR - http://www.scopus.com/inward/record.url?scp=84934285265&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84934285265&partnerID=8YFLogxK

U2 - 10.1542/peds.2014-3047

DO - 10.1542/peds.2014-3047

M3 - Review article

VL - 136

SP - 44

EP - 52

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 1

ER -