Clinical and economic outcomes of pneumonia in children: a longitudinal observational study in an Italian paediatric hospital.
OBJECTIVE
Antibiotic prescription for acute lower respiratory infections (ALRI) in hospitalized children can have a major impact on cure and costs. We performed a longitudinal study to explore the appropriateness of prescriptions, the predictors of therapeutic patterns, and the main outcomes: readmission, length of stay (LOS) and costs.


METHODS
Ninety-nine children who were inpatients of a paediatric hospital receiving antibiotic treatment for community acquired ALRI were consecutively enrolled. To calculate the costs of pneumonia treatment, we collected data on clinical presentation and resources consumption. We used multiple regression analysis to identify predictors of LOS and choice of therapy, and one-way ANOVA to evaluate cost differences among treatment groups.


RESULTS
Parenteral antibiotics were administered in 64.6% of cases, whereas 35.4% received oral antibiotic therapy by itself (OAT). Switch therapy (SWT) was performed in 43.4% of cases. The most frequently prescribed antibiotic for parenteral therapy was ceftriaxone (58.3%), and for oral therapy cefprozil (58.1%). The median LOS was 3 days and the cure rate 99% (95%CI: 97-100%). SWT and OAT were significantly associated with a shorter LOS. The clinical variables were not significantly associated with SWT or OAT. The average costs per patient in the management of pneumonia were Euro 1435. SWT or OAT were associated with significant lower costs: Euro 1487 per patient (95%CI: 1395-1580) and Euro 1335 per patient (95%CI: 1233-1437), respectively.


CONCLUSIONS
The hospital management of paediatric pneumonia was more influenced by the early discharge policy than by clinical variables without under-cure.
Di Ciommo
V
V
Epidemiology Unit, Ospedale Pediatrico Bambino Gesù, Rome, Italy. diciommo@opbg.net
Russo
P
P
Attanasio
E
E
Di Liso
G
G
Graziani
C
C
Caprino
L
L
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D006776:Hospitals, Pediatric / Q000191:economics / Q000592:standards; D006801:Humans; D007223:Infant; D007558:Italy; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000188:drug therapy* / Q000191:economics*; D012044:Regression Analysis; D018709:Statistics, Nonparametric
D000900:Anti-Bacterial Agents