title: Comparative effectiveness of empiric antibiotics for community-acquired pneumonia.
abstract: OBJECTIVE
  Narrow-spectrum antibiotics are recommended as the first-line agent for children hospitalized with community-acquired pneumonia (CAP). There is little scientific evidence to support that this consensus-based recommendation is as effective as the more commonly used broad-spectrum antibiotics. The objective was to compare the effectiveness of empiric treatment with narrow-spectrum therapy versus broad-spectrum therapy for children hospitalized with uncomplicated CAP.
  
  
  METHODS
  This multicenter retrospective cohort study using medical records included children aged 2 months to 18 years at 4 children's hospitals in 2010 with a discharge diagnosis of CAP. Patients receiving either narrow-spectrum or broad-spectrum therapy in the first 2 days of hospitalization were eligible. Patients were matched by using propensity scores that determined each patient's likelihood of receiving empiric narrow or broad coverage. A multivariate logistic regression analysis evaluated the relationship between antibiotic and hospital length of stay (LOS), 7-day readmission, standardized daily costs, duration of fever, and duration of supplemental oxygen.
  
  
  RESULTS
  Among 492 patients, 52% were empirically treated with a narrow-spectrum agent and 48% with a broad-spectrum agent. In the adjusted analysis, the narrow-spectrum group had a 10-hour shorter LOS (P = .04). There was no significant difference in duration of oxygen, duration of fever, or readmission. When modeled for LOS, there was no difference in average daily standardized cost (P = .62) or average daily standardized pharmacy cost (P = .26).
  
  
  CONCLUSIONS
  Compared with broad-spectrum agents, narrow-spectrum antibiotic coverage is associated with similar outcomes. Our findings support national consensus recommendations for the use of narrow-spectrum antibiotics in children hospitalized with CAP.
authors: Division of Pediatric Hospital Medicine, Children's Mercy Hospitals & Clinics, 2401 Gillham Rd, Kansas City, MO 64108. mqueen@cmh.edu.
authors: Mary Ann
authors: MA
authors: Queen
authors: Angela L
authors: AL
authors: Myers
authors: Matthew
authors: M
authors: Hall
authors: Samir S
authors: SS
authors: Shah
authors: Derek J
authors: DJ
authors: Williams
authors: Katherine A
authors: KA
authors: Auger
authors: Karen E
authors: KE
authors: Jerardi
authors: Angela M
authors: AM
authors: Statile
authors: Joel S
authors: JS
authors: Tieder
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy; D057186:Comparative Effectiveness Research; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D016015:Logistic Models; D018942:Macrolides / Q000627:therapeutic use*; D008297:Male; D016555:Matched-Pair Analysis; D015999:Multivariate Analysis; D010406:Penicillins / Q000627:therapeutic use*; D011014:Pneumonia / Q000188:drug therapy*; D057216:Propensity Score; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones; D018942:Macrolides; D010406:Penicillins
keywords: antibiotics; comparative effectiveness; hospitalized; pediatric; pneumonia