In the Journals

PIDS, IDSA pneumonia guidelines associated with increase in unscheduled follow-ups

Pediatric primary care providers adhere to many parts of the Pediatric Infectious Disease Society’s and the Infectious Diseases Society of America’s guidelines related to the diagnosis and treatment of community-acquired pneumonia, including limited use of chest radiographs and complete blood cell counts, according to research published in Pediatrics. However, adherence to guideline-recommended antibiotic therapy was associated with unscheduled follow-up visits for children aged older than 5 years, researchers said.

Lilliam Ambroggio, PhD, MPH, assistant professor at the University of Cincinnati’s department of pediatrics, and colleagues wrote that community-acquired pneumonia (CAP) is commonly diagnosed in outpatient settings, with more than 1.2 million children diagnosed in outpatient settings and EDs annually. According to the researchers, most of the antibiotic prescribing for these patients occur in outpatient settings.

“In 2011, members of the [Pediatric Infectious Disease Society (PIDS)] and [Infectious Diseases Society of America (IDSA)] published an evidence-based guideline for the management of CAP in children,” the researchers wrote. “The authors of the recommendations encourage prescribing narrow-spectrum antibiotics, increasing reliance on vital sign measurements — including pulse oximetry — for clinical decision-making and reducing the routine performance of laboratory testing and radiography.”

To assess whether physicians adhere to these guidelines and the relationship between guideline adherence and unscheduled follow-up visits, Ambroggio and colleagues conducted a stepped-wedge study that included immunocompetent children aged 3 months and older with no complex chronic conditions and a CAP diagnosis. Interventions related to guideline adherence were focused on education, how their colleagues prescribe medication for the condition and feedback provided by physicians.

Results showed an increase in compliance with practices recommended in the guidelines. Of the 1,906 children diagnosed with CAP, the use of guideline-recommended therapy increased from an average baseline of 24.9% to an average of 68%. Additionally, the use of pulse oximetry increased from 4.3% to 85%. The researchers also observed that chest radiographs and complete blood cell counts were not frequently used.

When physicians used guideline-recommended antibiotic treatment in children aged older than 5 years, children were more likely to have an unscheduled follow-up when compared with those who received nonguideline therapies (adjusted OR, 2.12; 95% CI, 1.31-3.43). This trend was not observed in children aged younger than 5 years.

“Most of the children who were categorized as not receiving guideline-recommended antibiotic therapy received macrolide monotherapy — 73% in the preintervention period and 41% in the intervention period,” Ambroggio and colleagues wrote. “However, a change in antibiotics at the unscheduled follow-up visit occurred in less than 5% of the children who received macrolide monotherapy... These results may indicate that a subpopulation of children with pneumonia, presumably caused by atypical bacteria, may benefit from [these antibiotics].” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.

Pediatric primary care providers adhere to many parts of the Pediatric Infectious Disease Society’s and the Infectious Diseases Society of America’s guidelines related to the diagnosis and treatment of community-acquired pneumonia, including limited use of chest radiographs and complete blood cell counts, according to research published in Pediatrics. However, adherence to guideline-recommended antibiotic therapy was associated with unscheduled follow-up visits for children aged older than 5 years, researchers said.

Lilliam Ambroggio, PhD, MPH, assistant professor at the University of Cincinnati’s department of pediatrics, and colleagues wrote that community-acquired pneumonia (CAP) is commonly diagnosed in outpatient settings, with more than 1.2 million children diagnosed in outpatient settings and EDs annually. According to the researchers, most of the antibiotic prescribing for these patients occur in outpatient settings.

“In 2011, members of the [Pediatric Infectious Disease Society (PIDS)] and [Infectious Diseases Society of America (IDSA)] published an evidence-based guideline for the management of CAP in children,” the researchers wrote. “The authors of the recommendations encourage prescribing narrow-spectrum antibiotics, increasing reliance on vital sign measurements — including pulse oximetry — for clinical decision-making and reducing the routine performance of laboratory testing and radiography.”

To assess whether physicians adhere to these guidelines and the relationship between guideline adherence and unscheduled follow-up visits, Ambroggio and colleagues conducted a stepped-wedge study that included immunocompetent children aged 3 months and older with no complex chronic conditions and a CAP diagnosis. Interventions related to guideline adherence were focused on education, how their colleagues prescribe medication for the condition and feedback provided by physicians.

Results showed an increase in compliance with practices recommended in the guidelines. Of the 1,906 children diagnosed with CAP, the use of guideline-recommended therapy increased from an average baseline of 24.9% to an average of 68%. Additionally, the use of pulse oximetry increased from 4.3% to 85%. The researchers also observed that chest radiographs and complete blood cell counts were not frequently used.

When physicians used guideline-recommended antibiotic treatment in children aged older than 5 years, children were more likely to have an unscheduled follow-up when compared with those who received nonguideline therapies (adjusted OR, 2.12; 95% CI, 1.31-3.43). This trend was not observed in children aged younger than 5 years.

“Most of the children who were categorized as not receiving guideline-recommended antibiotic therapy received macrolide monotherapy — 73% in the preintervention period and 41% in the intervention period,” Ambroggio and colleagues wrote. “However, a change in antibiotics at the unscheduled follow-up visit occurred in less than 5% of the children who received macrolide monotherapy... These results may indicate that a subpopulation of children with pneumonia, presumably caused by atypical bacteria, may benefit from [these antibiotics].” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.