Comparative effectiveness of empiric β-lactam monotherapy and β-lactam-macrolide combination therapy in children hospitalized with community-acquired pneumonia.
OBJECTIVE
To determine the comparative effectiveness of β-lactam monotherapy and β-lactam and macrolide combination therapy on clinical outcomes in the treatment of children hospitalized with community-acquired pneumonia (CAP).


METHODS
This multicenter retrospective cohort study included children aged 1-18 years who were hospitalized with CAP and received β-lactam antibiotic therapy either alone or in combination with a macrolide. Data were obtained from the Pediatric Health Information System. Associations between empiric antibiotic therapy and hospital readmission for the same episode of pneumonia were estimated using exact logistic regression. Associations between empiric antibiotic therapy and length of hospital stay were estimated using a generalized estimating equation with negative binomial distribution.


RESULTS
There were 20 743 patients hospitalized with CAP. Of these, 24% received β-lactam and macrolide combination therapy on admission. Compared with children who received β-lactam monotherapy, children who received β-lactam plus macrolide combination therapy were 20% less likely to stay in the hospital an additional day (adjusted relative risk 0.80; 95% CI, 0.75-0.86) but did not have a different readmission rate (relative risk 0.69; 95% CI, 0.41-1.12). An effect of combination treatment on reduced length of stay was not evident in children <6 years of age but increased with increasing age groups thereafter.


CONCLUSIONS
School-aged patients hospitalized with CAP who received β-lactam plus macrolide combination therapy have a shorter length of stay and similar rates of readmission compared with school-aged patients who receive β-lactam monotherapy.
Department of Epidemiology and Biostatics, Drexel University, Philadelphia, PA, USA. lilliam.ambroggio@cchmc.org
Lilliam
L
Ambroggio
Jennifer A
JA
Taylor
Loni Philip
LP
Tabb
Craig J
CJ
Newschaffer
Alison A
AA
Evans
Samir S
SS
Shah
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016010:Binomial Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy; D057186:Comparative Effectiveness Research; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D018942:Macrolides / Q000627:therapeutic use*; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D047090:beta-Lactams / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D018942:Macrolides; D047090:beta-Lactams