Impact of Chest Radiography on Antibiotic Treatment for Children With Suspected Pneumonia

Nelson, Kyle A.; Morrow, Christopher J.; Wingerter, Sarah L.; Bachur, Richard G.; Neuman, Mark I.

doi:10.1097/pec.0000000000000868

Cited by 35 publications

(37 citation statements)

References 20 publications

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“…Introduction of a clinical pathway for young febrile infants showed reduced time to first antibiotic dose, but did not evaluate the effect on antibiotic prescription itself ( 53 ). The use of chest radiographs in particular reduces antibiotics in children with low clinical suspicion of pneumonia ( 54 ). For all other interventions no significant reduction was found on antibiotic prescription ( 46 , 49 , 65 , 69 , 70 ).…”

Section: Resultsmentioning

confidence: 99%

Antibiotic Use in Febrile Children Presenting to the Emergency Department: A Systematic Review

et al. 2018

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Introduction: While fever is the main complaint among pediatric emergency services and high antibiotic prescription are observed, only a few studies have been published addressing this subject. Therefore this systematic review aims to summarize antibiotic prescriptions in febrile children at the ED and assess its determinants.Methods: We extracted studies published from 2000 to 2017 on antibiotic use in febrile children at the ED from different databases. Author, year, and country of publishing, study design, inclusion criteria, primary outcome, age, and number of children included in the study was extracted. To compare the risk-of-bias all articles were assessed using the MINORS criteria. For the final quality assessment we additionally used the sample size and the primary outcome.Results: We included 26 studies reporting on antibiotic prescription and 28 intervention studies on the effect on antibiotic prescription. In all 54 studies antibiotic prescriptions in the ED varied from 15 to 90.5%, pending on study populations and diagnosis. Respiratory tract infections were mostly studied. Pediatric emergency physicians prescribed significantly less antibiotics then general emergency physicians. Most frequent reported interventions to reduce antibiotics are delayed antibiotic prescription in acute otitis media, viral testing and guidelines.Conclusion: Evidence on antibiotic prescriptions in children with fever presenting to the ED remains inconclusive. Delayed antibiotic prescription in acute otitis media and guidelines for fever and respiratory infections can effectively reduce antibiotic prescription in the ED. The large heterogeneity of type of studies and included populations limits strict conclusions, such a gap in knowledge on the determining factors that influence antibiotic prescription in febrile children presenting to the ED remains.

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Section: Resultsmentioning

confidence: 99%

Antibiotic Use in Febrile Children Presenting to the Emergency Department: A Systematic Review

et al. 2018

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“…31 Previous studies have reported that antibiotic prescribing is not statistically impacted by the radiologist's impression from the CXR. 21,32 Therefore, ED CXR results were not included in determining the propensity score. A 1:1 nearestneighbor matching without replacement based on propensity score was executed by using the MatchIt package in the R statistical program.…”

Section: Figurementioning

confidence: 99%

Antibiotic Use and Outcomes in Children in the Emergency Department With Suspected Pneumonia

Lipshaw¹,

Eckerle

Florin

et al. 2020

Pediatrics

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BACKGROUND AND OBJECTIVES: Antibiotic therapy is often prescribed for suspected communityacquired pneumonia (CAP) in children despite a lack of knowledge of causative pathogen. Our objective in this study was to investigate the association between antibiotic prescription and treatment failure in children with suspected CAP who are discharged from the hospital emergency department (ED). METHODS: We performed a prospective cohort study of children (ages 3 months-18 years) who were discharged from the ED with suspected CAP. The primary exposure was antibiotic receipt or prescription. The primary outcome was treatment failure (ie, hospitalization after being discharged from the ED, return visit with antibiotic initiation or change, or antibiotic change within 7-15 days from the ED visit). The secondary outcomes included parentreported quality-of-life measures. Propensity score matching was used to limit potential bias attributable to treatment selection between children who did and did not receive an antibiotic prescription. RESULTS: Of 337 eligible children, 294 were matched on the basis of propensity score. There was no statistical difference in treatment failure between children who received antibiotics and those who did not (odds ratio 1.0; 95% confidence interval 0.45-2.2). There was no difference in the proportion of children with return visits with hospitalization (3.4% with antibiotics versus 3.4% without), initiation and/or change of antibiotics (4.8% vs 6.1%), or parentreported quality-of-life measures. CONCLUSIONS: Among children with suspected CAP, the outcomes were not statistically different between those who did and did not receive an antibiotic prescription.

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“…9 Authors of another study found that ED providers who had a high suspicion of pneumonia for their patients had a sixfold increased odds of prescribing antibiotics regardless of CXR results, revealing that CXR findings do not typically alter a provider's decision to prescribe antibiotics. 30 No statistical differences in antibiotic prescribing between the preintervention and intervention periods was detected, although there was a 4.7% decrease in the ordering of CXRs during the study period. We support the recommendation that CXRs are not routinely required for the diagnoses of CAP in the PPCP.…”

Section: Figurementioning

confidence: 78%

Guideline Adoption for Community-Acquired Pneumonia in the Outpatient Setting

et al. 2018

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Community-acquired pneumonia (CAP) is diagnosed in >1.2 million children in outpatient settings and emergency departments (EDs) each year in the United States. 1, 2 Most antibiotic prescribing for CAP occurs in the outpatient setting. In 2011, members of the Pediatric Infectious Diseases Society and Infectious Diseases Society of America published an evidence-based guideline for the management of CAP in children. The authors of the recommendations encourage prescribing narrow

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Impact of Chest Radiography on Antibiotic Treatment for Children With Suspected Pneumonia

Abstract: Among children with high suspicion for pneumonia, CXRs infrequently altered the initial plan for antibiotics. However, when clinical suspicion for pneumonia was low, the use of CXR may reduce unnecessary antibiotic use.

Cited by 35 publications

References 20 publications

Antibiotic Use in Febrile Children Presenting to the Emergency Department: A Systematic Review

Antibiotic Use in Febrile Children Presenting to the Emergency Department: A Systematic Review

Antibiotic Use and Outcomes in Children in the Emergency Department With Suspected Pneumonia

Guideline Adoption for Community-Acquired Pneumonia in the Outpatient Setting

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