title: Adjunct Systemic Corticosteroid Therapy in Children With Community-Acquired Pneumonia in the Outpatient Setting.
abstract: BACKGROUND
  The role of adjunct systemic corticosteroid therapy in children with community-acquired pneumonia (CAP) is not known. The objective was to determine the association between adjunct systemic corticosteroid therapy and treatment failure in children who received antibiotics for treatment of CAP in the outpatient setting.
  
  
  METHODS
  The study included a retrospective cohort study of children, aged 1-18 years, with a diagnosis of CAP who were managed at an outpatient practice affiliated with Geisinger Health System from January 1, 2008 to January 31, 2010. The primary exposure was the receipt of adjunct corticosteroid therapy. The primary outcome was treatment failure defined as a respiratory-associated follow-up within 14 days of diagnosis in which the participant received a change in antibiotic therapy. The probability of receiving adjunct systemic corticosteroid therapy was calculated using a matched propensity score. A multivariable conditional logistic regression model was used to estimate the association between adjunct corticosteroids and treatment failure.
  
  
  RESULTS
  Of 2244 children with CAP, 293 (13%) received adjunct corticosteroids, 517 (23%) had underlying asthma, and 624 (28%) presented with wheezing. Most patients received macrolide monotherapy for their CAP diagnosis (n = 1329; 59%). Overall, treatment failure was not associated with adjunct corticosteroid treatment (odds ratio [OR], 1.72; 95% confidence interval [CI], 0.93 and 3.19), but the association was statistically significant among patients with no history of asthma (OR, 2.38; 95% CI, 1.03 and 5.52), with no statistical association among patients with a history of asthma.
  
  
  CONCLUSIONS
  Adjunct corticosteroid therapy was associated with treatment failure among children diagnosed with CAP who did not have underlying asthma.
authors.affiliation: Division of Hospital Medicine Division of Biostatistics and Epidemiology Department of Pediatrics, the University of Cincinnati College of Medicine, Ohio.
authors.forename: Lilliam
authors.initials: L
authors.lastname: Ambroggio
authors.affiliation: Division of Hospital Medicine.
authors.forename: Matthew
authors.initials: M
authors.lastname: Test
authors.affiliation: General Medicine Division, Massachusetts General Hospital, Boston.
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: Population Health, Geisinger Health System, Danville, Pennsylvania.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Blosky
authors.affiliation: Division of Biostatistics and Epidemiology Department of Pediatrics, the University of Cincinnati College of Medicine, Ohio.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Macaluso
authors.affiliation: Division of Hospital Medicine Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center Department of Pediatrics, the University of Cincinnati College of Medicine, Ohio.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001249:Asthma / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016015:Logistic Models; D015999:Multivariate Analysis; D010045:Outpatients / Q000706:statistics & numerical data; D011014:Pneumonia / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D011239:Prednisolone / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D012135:Respiratory Sounds / Q000187:drug effects; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D003907:Dexamethasone; D011239:Prednisolone; D011241:Prednisone
keywords: child; corticosteroid; pediatric; pneumonia.