Canadian Pediatricians’ Prescribing Practices for Community-Acquired Pneumonia

Pernica, Jeffrey M.; Mah, Jordan; Kam, April J.

doi:10.1177/0009922813488651

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…In contrast, in adults there is good evidence that 5 days of therapy is as effective as 7–10 days even in adults hospitalized because of CAP [ 7 , 8 ], and so 5 days of therapy is generally recommended [ 9 – 11 ]. A recent survey of Canadian providers showed that 50% of all emergency department (ED)-based physicians using β-lactams treat mild paediatric pneumonia with 10 or more days of therapy [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Short-course antimicrobial therapy for paediatric respiratory infections (SAFER): study protocol for a randomized controlled trial

Pernica

Harman

Kam

et al. 2018

Trials

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BackgroundCommunity-acquired pneumonia (CAP) is commonly diagnosed in children. The Infectious Disease Society of America guidelines recommend 10 days of high-dose amoxicillin for the treatment of non-severe CAP but 5-day “short course” therapy may be just as effective. Randomized trials in adults have already demonstrated non-inferiority of 5-day short-course treatment for adults hospitalized with severe CAP and for adults with mild CAP treated as outpatients. Minimizing exposure to antimicrobials is desirable to avoid harms including diarrhoea, rashes, severe allergic reactions, increased circulating antimicrobial resistance, and microbiome disruption.MethodsThe objective of this multicentre, randomized, non-inferiority, controlled trial is to investigate whether 5 days of high-dose amoxicillin is associated with lower rates of clinical cure 14–21 days later as compared to 10 days of high-dose amoxicillin, the reference standard. Recruitment and enrolment will occur in the emergency departments of McMaster Children’s Hospital and the Children’s Hospital of Eastern Ontario. All children in the study will receive 5 days of amoxicillin after which point they will receive either 5 days of a different formulation of amoxicillin or a placebo. Assuming a clinical failure rate of 5% in the reference arm, a non-inferiority margin of 7.5%, one-sided alpha set at 0.025 and power of 0.80, 270 participants will be required. Participants from a previous feasibility study (n = 60) will be rolled over into the current study. We will be performing multiplex respiratory virus molecular testing, quantification of nasopharyngeal pneumococcal genomic loads, salivary inflammatory marker testing, and faecal microbiome profiling on participants.DiscussionThis is a pragmatic study seeking to provide high-quality evidence for front-line physicians evaluating children presenting with mild CAP in North American emergency departments in the post-13-valent pneumococcal, conjugate vaccine era. High-quality evidence supporting the non-inferiority of short-course therapy for non-severe paediatric CAP should be generated prior to making changes to established guidelines. Trial registrationClinicalTrials.gov, NCT02380352. Registered on 2 March 2015.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2457-2) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Short-course antimicrobial therapy for paediatric respiratory infections (SAFER): study protocol for a randomized controlled trial

Pernica

Harman

Kam

et al. 2018

Trials

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“…Since routine diagnostics do not reliably differentiate between bacterial and viral infection, it is not surprising that most children diagnosed with CAP at our institution are treated with antibiotics, a common practice in North America 15 37 38. Unfortunately, many of these children have primary viral infections and receive antibiotics that will not help but may cause harm.…”

Section: Background and Rationalementioning

confidence: 99%

Novel care pathway to optimise antimicrobial prescribing for uncomplicated community-acquired pneumonia: study protocol for a prospective before–after cohort study in the emergency department of a tertiary care Canadian children’s hospital

et al. 2022

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IntroductionEvidence-based recommendations for paediatric community-acquired pneumonia (CAP) diagnosis and management are needed. Uncomplicated CAP is often caused by respiratory viruses, especially in younger children; these episodes self-resolve without antibiotic treatment. Unfortunately, there are no clinical criteria that reliably discriminate between viral and bacterial disease, and so the majority of children diagnosed with CAP are given antibiotics—even though these will often not help and may cause harm. We have developed a novel care pathway that incorporates point-of-care biomarkers, radiographic patterns, microbiological testing and targeted follow-up. The primary study objective is to determine if the care pathway will be associated with less antimicrobial prescribing.Methods and analysisA prospective, before–after, study. Previously well children aged≥6 months presenting to a paediatric emergency department (ED) that have at least one respiratory symptom/sign, receive chest radiography, and are diagnosed with CAP by the ED physician will be eligible. Those with medical comorbidities, recently diagnosed pulmonary infection, or ongoing fever after≥4 days of antimicrobial therapy will be excluded. In the control (before) phase, eligible participants will be managed as per the standard of care. In the intervention (after) phase, eligible participants will be managed as per the novel care pathway. The primary outcome will be the proportion of participants in each phase who receive antimicrobial treatment for CAP. The secondary outcomes include: clinical cure; re-presentation to the ED; hospitalisation; time to resolution of symptoms; drug adverse events; caregiver satisfaction; child absenteeism from daycare/school; and caregiver absenteeism from work.Ethics and disseminationAll study documentation has been approved by the Hamilton Integrated Research Ethics Board and informed consent will be obtained from all participants. Data from this study will be presented at major conferences and published in peer-reviewed publications to facilitate collaborations with networks of clinicians experienced in the dissemination of clinical guidelines.Trial registration numberNCT05114161.

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“…[4] However, present study rarely assesses the drug use to treat CAP in children. [9] In 2018, our research group developed a set of indicators to assess RDU for the treatment of CAP in children, which were applied to hospital departments and clinics to evaluate the rationality of drug use during a given period of time. [10] Therefore, the aim of this study was to assess the rationality of drug use to treat CAP in children using a set of developed indicators and to provide reference for clinical drug use by performing a retrospective cross-sectional study in a Chinese University Hospital.…”

Section: Introductionmentioning

confidence: 99%

The drug use to treat community-acquired pneumonia in children

Zhang

et al. 2018

Medicine

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To evaluate the rationality of drug use to treat community-acquired pneumonia (CAP) in children of a Chinese hospital using a set of developed indicators.We performed a retrospective cross-sectional study in West China Second University Hospital. Hospitalized children (0–18 years old) diagnosed with CAP from October 2015 to January 2016 were included. A set of developed indicators for assessing rational drug use (RDU) to treat CAP in children were used to evaluate the rationality of drug use. The data of the indicators were compared with the recommendations of the available guidelines, analyzing the situation of drug use in the children diagnosed with CAP.Eight hundred ninety-four children were included, 99.4% of them received antibiotics and 87.4% received more than 1 antibiotic. Antibiotics were administered intravenously in 880 (99.0%) children. About 20 (2.2%) children received antiviral agents and 19 (2.1%) children received antiviral drugs combined with antibiotics. About 208 (23.3%) children received traditional Chinese medicines and the injection of traditional Chinese medicines was given in 20 (2.2%) children.This study illustrated that drug use was partly not consistent with the recommendations of current guidelines, especially antibiotics. The drug use of CAP in children needs to pay more attention to.

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Canadian Pediatricians’ Prescribing Practices for Community-Acquired Pneumonia

Cited by 4 publications

References 9 publications

Short-course antimicrobial therapy for paediatric respiratory infections (SAFER): study protocol for a randomized controlled trial

Short-course antimicrobial therapy for paediatric respiratory infections (SAFER): study protocol for a randomized controlled trial

Novel care pathway to optimise antimicrobial prescribing for uncomplicated community-acquired pneumonia: study protocol for a prospective before–after cohort study in the emergency department of a tertiary care Canadian children’s hospital

The drug use to treat community-acquired pneumonia in children

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