title: Narrow vs broad-spectrum antimicrobial therapy for children hospitalized with pneumonia.
abstract: BACKGROUND
  The 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America community-acquired pneumonia (CAP) guideline recommends narrow-spectrum antimicrobial therapy for most children hospitalized with CAP. However, few studies have assessed the effectiveness of this strategy.
  
  
  METHODS
  Using data from 43 children's hospitals, we conducted a retrospective cohort study to compare outcomes and resource utilization among children hospitalized with CAP between 2005 and 2011 receiving either parenteral ampicillin/penicillin (narrow spectrum) or ceftriaxone/cefotaxime (broad spectrum). Children with complex chronic conditions, interhospital transfers, recent hospitalization, or the occurrence of any of the following during the first 2 calendar days of hospitalization were excluded: pleural drainage procedure, admission to intensive care, mechanical ventilation, death, or hospital discharge.
  
  
  RESULTS
  Overall, 13,954 children received broad-spectrum therapy (89.7%) and 1610 received narrow-spectrum therapy (10.3%). The median length of stay was 3 days (interquartile range 3-4) in the broad- and narrow-spectrum therapy groups (adjusted difference 0.12 days, 95% confidence interval [CI]: -0.02 to 0.26). One hundred fifty-six children (1.1%) receiving broad-spectrum therapy and 13 children (0.8%) receiving narrow-spectrum therapy were admitted to intensive care (adjusted odds ratio 0.85, 95% CI: 0.27 to 2.73). Readmission occurred for 321 children (2.3%) receiving broad-spectrum therapy and 39 children (2.4%) receiving narrow-spectrum therapy (adjusted odds ratio 0.85, 95% CI: 0.45 to 1.63). Median costs for the hospitalization were $3992 and $4375 (adjusted difference -$14.4, 95% CI: -177.1 to 148.3).
  
  
  CONCLUSIONS
  Clinical outcomes and costs for children hospitalized with CAP are not different when treatment is with narrow- compared with broad-spectrum therapy.
authors.affiliation: 1161 21st Ave South, CCC 5311 Medical Center North, Nashville, TN 37232. derek.williams@vanderbilt.edu.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Williams
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.forename: Kavita
authors.initials: K
authors.lastname: Parikh
authors.forename: Amy
authors.initials: A
authors.lastname: Tyler
authors.forename: Mark I
authors.initials: MI
authors.lastname: Neuman
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Brogan
authors.forename: Anne J
authors.initials: AJ
authors.lastname: Blaschke
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Grijalva
mesh_terms: D000667:Ampicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002439:Cefotaxime / Q000008:administration & dosage; D002443:Ceftriaxone / Q000008:administration & dosage; D002675:Child, Preschool; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007223:Infant; D008297:Male; D010406:Penicillins / Q000008:administration & dosage; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D002443:Ceftriaxone; D000667:Ampicillin; D002439:Cefotaxime
keywords: antibiotic use; effectiveness; pediatrics; pneumonia