title: Variability in pediatric infectious disease consultants' recommendations for management of community-acquired pneumonia.
abstract: BACKGROUND
  Community-acquired pneumonia (CAP) is a common childhood infection. CAP complications, such as parapneumonic empyema (PPE), are increasing and are frequently caused by antibiotic-resistant organisms. No clinical guidelines currently exist for management of pediatric CAP and no published data exist about variations in antibiotic prescribing patterns. Our objectives were to describe variation in CAP clinical management for hospitalized children by pediatric infectious disease consultants and to examine associations between recommended antibiotic regimens and local antibiotic resistance levels.
  
  
  METHODS
  We surveyed pediatric members of the Emerging Infections Network, which consists of 259 pediatric infectious disease physicians. Participants responded regarding their recommended empiric antibiotic regimens for hospitalized children with CAP with and without PPE and their recommendations for duration of therapy. Participants also provided information about the prevalence of penicillin non-susceptible S. pneumoniae and methicillin-resistant S. aureus (MRSA) in their community.
  
  
  RESULTS
  We received 148 responses (57%). For uncomplicated CAP, respondents were divided between recommending beta-lactams alone (55%) versus beta-lactams in combination with another class (40%). For PPE, most recommended a combination of a beta-lactam plus an anti-MRSA agent, however, they were divided between clindamycin (44%) and vancomycin (57%). The relationship between reported antibiotic resistance and empiric regimen was mixed. We found no relationship between aminopenicillin use and prevalence of penicillin non-suscepetible S. pneumoniae or clindamycin use and clindamycin resistance, however, respondents were more likely to recommend an anti-MRSA agent when MRSA prevalence increased.
  
  
  CONCLUSIONS
  Substantial variability exists in recommendations for CAP management. Development of clinical guidelines via antimicrobial stewardship programs and dissemination of data about local antibiotic resistance patterns represent opportunities to improve care.
authors.affiliation: Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah, United States of America. adam.hersh@hsc.utah.edu
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Shapiro
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newland
authors.forename: Philip M
authors.initials: PM
authors.lastname: Polgreen
authors.forename: Susan E
authors.initials: SE
authors.lastname: Beekmann
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002981:Clindamycin / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000382:microbiology; D003625:Data Collection; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D011014:Pneumonia / Q000188:drug therapy* / Q000382:microbiology; D014640:Vancomycin / Q000627:therapeutic use; D047090:beta-Lactams / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D002981:Clindamycin; D014640:Vancomycin