title: Impact of a guideline on management of children hospitalized with community-acquired pneumonia.
abstract: OBJECTIVE
  We sought to describe the impact a clinical practice guideline (CPG) had on antibiotic management of children hospitalized with community-acquired pneumonia (CAP).
  
  
  METHODS
  We conducted a retrospective study of discharged patients from a children's hospital with an ICD-9-CM code for pneumonia (480-486). Eligible patients were admitted from July 8, 2007, through July 9, 2009, 12 months before and after the CAP CPG was introduced. Three-stage least squares regression analyses were performed to examine hypothesized simultaneous relationships, including the impact of our institution\x{2019}s antimicrobial stewardship program (ASP).
  
  
  RESULTS
  The final analysis included 1033 patients: 530 (51%) before the CPG (pre-CPG) and 503 (49%) after the CPG (post-CPG). Pre-CPG, ceftriaxone (72%) was the most commonly prescribed antibiotic, followed by ampicillin (13%). Post-CPG, the most common antibiotic was ampicillin (63%). The effect of the CPG was associated with a 34% increase in ampicillin use (P < .001). Discharge antibiotics also changed post-CPG, showing a significant increase in amoxicillin use (P < .001) and a significant decrease in cefdinir and amoxicillin/clavulanate (P < .001), with the combined effect of the CPG and ASP leading to 12% (P < 0.001) and 16% (P < .001) reduction, respectively.  Overall, treatment failure was infrequent (1.5% vs 1%).
  
  
  CONCLUSIONS
  A CPG and ASP led to the increase in use of ampicillin for children hospitalized with CAP. In addition, less broad-spectrum discharge antibiotics were used. Patient adverse outcomes were low, indicating that ampicillin is appropriate first-line therapy for otherwise healthy children admitted with uncomplicated CAP.
authors.affiliation: Section of General Pediatrics, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Children’s Mercy Hospitals and Clinics, Kansas City, MO 64108, USA.
authors.forename: Ross E
authors.initials: RE
authors.lastname: Newman
authors.forename: Erin B
authors.initials: EB
authors.lastname: Hedican
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Herigon
authors.forename: David D
authors.initials: DD
authors.lastname: Williams
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Williams
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newland
mesh_terms: D017677:Age Distribution; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D038801:International Classification of Diseases; D008297:Male; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D017410:Practice Guidelines as Topic / Q000592:standards*; D013902:Radiography, Thoracic; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents