Restrictive antibiotic use in children hospitalized for pneumonia: A retrospective inpatient study

Abstract

IntroductionReducing antibiotic use is a global priority, but the extent to which antibiotic prescriptions can be reduced in children hospitalized for community-acquired pneumonia is unknown. This study aimed to analyse the prescribing experience from a facility with a long-standing practice of restrictive antibiotic use. MethodsWe conducted a retrospective analysis of children from birth to 18 years, hospitalized for pneumonia at an integrative medicine hospital in Germany. Antibiotic prescription rate and clinical outcomes were analyzed. The Moreno Bacterial Pneumonia Score, a composite laboratory, clinical and radiologic score, was applied to estimate the proportion of viral and bacterial pneumonia. Results252 pneumonia episodes were included, with 172 categorized as probably viral and 80 as bacterial pneumonia. Antibiotic prescription rate was 32 % overall, 26 % for presumed viral and 51 % for presumed bacterial pneumonia. Children with probable bacterial pneumonia who were managed with antibiotics had higher CRP values than those managed without antibiotics (p < 0.001). 13 % of bacterial pneumonia episodes initially managed without antibiotics received antibiotics after hospital day 2. Hospitalization duration was longer for bacterial pneumonia episodes managed with antibiotics than those managed without (7.0 versus 4.9 days, p = 0.003). ConclusionsThe observed antibiotic prescription rate of 32 % was much lower than rates reported in the literature - 88–98 %. Children were safely managed with a restrictive antibiotic prescription strategy when physicians judged this to be appropriate. Our findings suggest that a delayed prescription strategy for childhood pneumonia deserves further study. Trial registrationthe study was registered at clinicaltrials.org, NCT03256474.