title: Effectiveness of antimicrobial guidelines for community-acquired pneumonia in children.
abstract: OBJECTIVE
  To assess the effectiveness of guidelines and education on empirical therapy for community-acquired pneumonia.
  
  
  METHODS
  Administrative records for children with a primary diagnosis of pneumonia from January 2007 to September 2009 were reviewed. Antimicrobial use was measured monthly over 3 periods: (1) before creation of an antimicrobial stewardship task force (ASTF), (2) after ASTF formation but before release of guidelines for antimicrobial use, and (3) after guideline release. Antimicrobial use over time was assessed by using quasi-binomial logistic regression models that incorporated interrupted events, seasonality, and autocorrelation. Allowing calculation of immediate changes due to specific interventions and trends in use over each time period. The primary outcome was use of ampicillin as recommended in the guidelines versus ceftriaxone, the historical standard. Secondary outcomes included other antimicrobial use, length of stay, mortality, and readmission.
  
  
  RESULTS
  One thousand two hundred forty-six children met study criteria. Ampicillin use increased from 2% at baseline to 6% after ASTF formation and 44% after guideline release. Ceftriaxone use increased slightly (from 56% to 59%) after ASTF formation but decreased to 28% after guideline release. An immediate change in prescription occurred in the month after guideline publication and remained stable over the following year.
  
  
  CONCLUSIONS
  Guidelines and education can have an impact on antimicrobial use in the pediatric setting. Although the optimal strategies for pediatric antimicrobial stewardship programs still are being determined, we believe that our approach offers an inexpensive and low-risk step in the right direction.
authors.affiliation: Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA. mjsmit22@louisville.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Smith
authors.forename: Maiying
authors.initials: M
authors.lastname: Kong
authors.forename: Alex
authors.initials: A
authors.lastname: Cambon
authors.forename: Charles R
authors.initials: CR
authors.lastname: Woods
mesh_terms: D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000401:mortality; D032921:Consensus; D057915:Drug Substitution; D004363:Drug Utilization / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007318:Inservice Training; D007629:Kentucky; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D010359:Patient Readmission; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000401:mortality; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy / Q000401:mortality; D010818:Practice Patterns, Physicians'; D016019:Survival Analysis; D016896:Treatment Outcome; D014640:Vancomycin / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D014640:Vancomycin; D002443:Ceftriaxone; D000667:Ampicillin; D017963:Azithromycin