Narrow-spectrum and broad-spectrum antibiotics effective for inpatient pneumonia

Investigators compared outcomes in hospitalized children with community-acquired pneumonia who were treated with a narrow-spectrum antibiotic (ampicillin/penicillin) versus a broad-spectrum agent (ceftriaxone/cefotaxime), each by a parenteral route. The retrospective review included data for more than 15,000 children, aged 6 months to 18 years, who were admitted to 43 children’s hospitals from 2005 to 2011.

To control for severity of disease on admission, patients with chronic conditions, complicated pneumonia, those requiring intensive care, and those hospitalized for fewer than 2 days were excluded from the study. No significant differences in length of stay, costs, or need for intensive care or readmission were seen between children treated with narrow-spectrum and broad-spectrum therapies.

The vast majority of children (89.7%) received broad-spectrum therapy rather than narrow-spectrum therapy (10.3%). Median length of stay was 3 days in both groups, and 1.1% of patients receiving broad-spectrum therapy and 0.8% of those receiving narrow-spectrum therapy were admitted to intensive care. Readmission rates also were similar for the broad-spectrum and narrow-spectrum groups: 2.3% and 2.4%, respectively. Although median hospitalization costs were higher among children receiving narrow-spectrum therapy ($4,375) than among those receiving broad-spectrum treatment ($3,992), these differences were not statistically significant in adjusted analyses (Williams DJ, et al. Pediatrics. 2013;132[5]:e1141-e1148).

COMMENTARY  The researchers estimate that 150,000 US children are admitted with pneumonia each year. If, as in this study, nearly 90% of these children receive broad-spectrum antibiotic coverage rather than the more targeted coverage recommended by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America (Clin Infect Dis. 2011;53[7]:e25-e76), a change in practice could go a long way toward suppressing development of antibiotic resistance. This could be accomplished with no measurable impact on clinical outcome for these children. -Michael Burke, MD

MS FREEDMAN is a freelance medical editor and writer in New Jersey. DR BURKE, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. He is a contributing editor for Contemporary Pediatrics. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.