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Children’s hospitals more likely to give recommended antibiotics for pneumonia

(Reuters Health) – Kids with pneumonia may be more likely to receive recommended antibiotics when they’re treated at a children’s hospital than when they’re seen elsewhere, a U.S. study suggests.

While milder cases of pneumonia may clear up without treatment, antibiotics are recommended for more serious cases that can lead to potentially fatal lung infections. Since 2011, U.S. guidelines have recommended so-called narrow spectrum antibiotics – penicillin, amoxicillin, and ampicillin – for kids hospitalized for pneumonia.

For the study, researchers examined data on antibiotic use for 120,238 kids treated for pneumonia at 51 children’s hospitals and 471 non-children’s hospitals from January 2009 through September 2015.

During the study period, the proportion of children’s hospitals giving narrow-spectrum antibiotics to kids with so-called community acquired pneumonia – or cases caught outside the hospital – increased from 25 percent to 61 percent, researchers report in JAMA Pediatrics. At other hospitals, the proportion of these kids who received recommended antibiotics climbed from six percent to 27 percent.

“Narrow-spectrum antibiotics are recommended over broad-spectrum antibiotics because narrow-spectrum antibiotics provide similar (and sometime better) clinical cure rates, are less likely to cause antibiotic-resistance, typically have fewer side effects (like diarrhea), and are less expensive,” said senior study author Dr. Jeffrey Gerber of the University of Pennsylvania School of Medicine and Children’s Hospital of Philadelphia.

These findings come at a time when hospitals nationwide are increasingly grappling with antibiotic-resistant “superbugs” that don’t respond to available medicines. Antibiotic resistance has become increasingly common, and older drugs have become less effective, in part because of overuse.

Sometimes overuse results from incorrectly giving patients antibiotics for viral infections like the flu that won’t respond to these drugs. Other times, however, overuse involves giving patients an antibiotic that’s less effective for their condition before switching to a different antibiotic that’s better suited to their illness.

The study wasn’t a controlled experiment designed to prove whether or how treatment at a children’s hospital might directly influence the chances of kids receiving the recommended antibiotics for pneumonia.

“One possibility is that clinicians who work in children’s hospitals could be more likely to be aware of pediatric guidelines and/or benefit from a more robust infrastructure to support the care of children than those who do not work in this setting,” Gerber said by email.

“For example, at Children’s Hospital of Philadelphia, we have a clinical quality improvement team that generates, updates, and disseminates guidelines for managing common pediatric illnesses as well as an Antimicrobial Stewardship Program that ensures that children receive the correct choice, dose, and duration of antibiotics,” Gerber added.

But about 70 percent of hospitalized children don’t receive care at children’s hospitals, the study authors note.

It’s unlikely that children’s hospitals are treating different patient populations than other hospitals that could explain the difference in antibiotic use in the study because researchers only looked at healthy children with uncomplicated community acquired pneumonia, the authors write.

The results suggest that there’s a need for more programs focused on antibiotic stewardship at hospitals that don’t specialize in treating children, the authors conclude.

“This is one example of a scenario where, in general, children who are cared for in children’s hospitals appear to be receiving more guideline-recommended care than those who are not.

SOURCE: JAMA Pediatrics, online December 10, 2018.

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