Observational Study Questions the Routine use of Antibiotics for Pediatric Pneumonia
Published April 2020 | Pediatrics
Younger children with pneumonia, especially those who are well enough to be treated outside of the hospital, are unlikely to have a bacterial infection and may not need routine treatment with antibiotics, according to experts with the Division of Emergency Medicine.
The prospective cohort study of 294 children ages 3 months to 18 years found no distinct difference in treatment failure—defined as hospitalization after being discharged from the ED, a return ED visit with to initiate or change antibiotics, or antibiotic change within 7-15 days of the ED visit—between children who were prescribed antibiotics and those who were not. Quality-of-life measures as reported by the pediatric patients’ parents also were similar.
The findings call into question the common practice of prescribing antibiotics for pediatric pneumonia in children, given the high prevalence of a viral cause for community-acquired pneumonia. Studies elsewhere also have identified low levels of bacterial pneumonia in the pediatric population, including research that used blood and nasopharyngeal polymerase chain reaction testing of pediatric patients; 14% of the pneumonia cases were bacterial, and 73% were viral in nature.
“Currently, there is no reliable way to differentiate viral from bacterial pneumonia,” says Matthew Lipshaw, MD, MS, who participated in the study with emergency medicine colleagues Richard Ruddy, MD, and Michelle Eckerle, MD, and Samir Shah, MD, MSCE, from the Division of Hospital Medicine. “Further work is needed to determine which children with pneumonia are more likely to have bacterial disease and which are likely to develop complications without antibiotics.”
Follow-up studies will involve a multi-center randomized, controlled trial to compare treatment with antibiotics vs. placebo in children at low risk of complications from community-acquired pneumonia.
