Évaluation des prescriptions dans la prise en charge des pneumonies aiguës communautaires de l’enfant

Abstract

To determine how national recommendations for the treatment of acute community-acquired pneumonia (CAP) are applied in children. A phone survey was conducted in northern France. A standardized questionnaire was submitted to randomized general practitioners (GPs), private pediatricians, and pediatric fellows to analyze their practices for CAP in children. Diagnostic and treatment data were collected for the last child they had treated for CAP and for a factitious clinical case of CAP. Treatments, particularly prescribing antibiotics, were compared to the guidelines published in 2005 for lower respiratory tract infections, in order to determine the percentage of "good prescribers". A total of 101 physicians were involved: 77 senior physicians (62 GPs and 15 private pediatricians) and 24 pediatric fellows. For the last child treated for a CAP (mean age: 4.5 years±3.4), amoxicillin was prescribed in 29% of cases and associated (most of the time by GPs) with clavulanic acid in 54%. For the factitious clinical case (age: 3 years), amoxicillin alone was prescribed in 50% of cases and associated with clavulanic acid in 45%. Also considering recommended doses and length of treatment, the percentage of "good prescribers" for senior physicians for each situation was 15% and 16%, respectively, and for pediatric residents was 52% and 50%. Guidelines for CAP in children were insufficiently followed.