Use of narrow-spectrum antibiotics for pneumonia increases after release of guideline
A recent study found that national guidelines designed to improve the treatment of pneumonia led to increased use of penicillin/ampicillin in adherence with the guideline recommendations.
“To assist clinicians in caring for children with community-acquired pneumonia, a committee convened by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America comprehensively reviewed best available evidence for the management of childhood CAP [community-acquired pneumonia], culminating in the release of the first national consensus management guidelines in August 2011,” Derek J. Williams, MD, MPH, of the department of pediatrics at Vanderbilt University School of Medicine, and colleagues wrote. “The recommendation for narrow-spectrum antibiotic therapy advocated a major shift in practice.”
To assess the influence of these guidelines, researchers analyzed the treatment of 2,121 children diagnosed with CAP across three hospitals from January 2010 through June 2012, before and after publication of the guidelines. The researchers calculated the monthly percentage of pediatric patients who were given broader-range, third-generation cephalosporin antibiotics to determine the effectiveness of hospital-level guideline implementation efforts.
Results showed that before implementation, 52.8% of pediatric CAP patients were treated with broad-spectrum antibiotics, while only 2.7% of patients received narrow-spectrum antibiotics such as penicillin/ampicillin.
At the conclusion of the study period, use of third-generation cephalosporin antibiotics decreased by an absolute difference of 12.4% (95% CI, –19.8% to –5.1%). However, use of narrow-range antibiotics rose by an absolute difference of 11.3% (95% CI, 4.3%- 18.3%), as recommended by the guidelines.
The researchers said that hospital-based education programs implemented immediately after release of the pneumonia guidelines correlated with a decreased use of third-generation cephalosporins. Hospital-based interventions included establishing management guidelines and physician order sets.
“Additional studies in a variety of settings are needed to monitor the spread and long-term sustainability of these initial encouraging observations and to identify the most effective hospital-based strategies to facilitate rapid implementation of national guidelines,” the researchers concluded. – by David Costill
Disclosure: The researchers report no relevant financial disclosures.