title: Beta-lactam versus beta- lactam/macrolide therapy in pediatric outpatient pneumonia.
abstract: OBJECTIVE
  The objective was to evaluate the comparative effectiveness of beta-lactam monotherapy and beta- lactam/macrolide combination therapy in the outpatient management of children with community-acquired pneumonia (CAP).
  
  
  METHODS
  This retrospective cohort study included children, ages 1-18 years, with CAP diagnosed between January 1, 2008 and January 31, 2010 during outpatient management in the Geisinger Health System. The primary exposure was receipt of beta-lactam monotherapy or beta-lactam/macrolide combination therapy. The primary outcome was treatment failure, defined as a follow-up visit within 14 days of diagnosis resulting in a change in antibiotic therapy. Logistic regression within a propensity score- restricted cohort was used to estimate the likelihood of treatment failure.
  
  
  RESULTS
  Of 717 children in the analytical cohort, 570 (79.4%) received beta-lactam monotherapy and 147 (20.1%) received combination therapy. Of those who received combination therapy 58.2% of children were under 6 years of age. Treatment failure occurred in 55 (7.7%) children, including in 8.1% of monotherapy recipients, and 6.1% of combination therapy recipients. Treatment failure rates were highest in children 6-18 years receiving monotherapy (12.9%) and lowest in children 6-18 years receiving combination therapy (4.0%). Children 6-18 years of age who received combination therapy were less likely to fail treatment than those who received beta-lactam monotherapy (propensity-adjusted odds ratio, 0.51; 95% confidence interval, 0.28, 0.95).
  
  
  CONCLUSIONS
  Children 6-18 years of age who received beta- lactam/macrolide combination therapy for CAP in the outpatient setting had lower odds of treatment failure compared with those who received beta-lactam monotherapy.
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.|Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.|Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Lilliam
authors.initials: L
authors.lastname: Ambroggio
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Matthew
authors.initials: M
authors.lastname: Test
authors.affiliation: Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Metlay
authors.affiliation: Population Health, Geisinger Health System, Danville, Pennsylvania.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Graf
authors.affiliation: Center for Health Research, Geisinger Health System, Danville, Pennsylvania.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Blosky
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.|Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Macaluso
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.|Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.|Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D018942:Macrolides / Q000627:therapeutic use*; D008297:Male; D010045:Outpatients; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D047090:beta-Lactams / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides; D047090:beta-Lactams
keywords: amoxicillin; child; comparative effectiveness research; pediatric; pneumonia; pneumonia bacterial