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Too many Antibiotics and Chest X-rays for Children with Pneumonia?

A recent study shows that preschool children with community-acquired pneumonia often receive unnecessary tests and treatment at outpatient clinics and emergency departments.

Preschool children with community-acquired pneumonia often receive unnecessary tests and treatment at outpatient clinics and emergency departments, according to a nationally representative study led by Todd Florin, MD, MSCE, from Ann & Robert H. Lurie Children's Hospital of Chicago.

The researchers found that while most cases of community-acquired pneumonia in young children are caused by viruses, for which antibiotics provide no benefit, antibiotics were prescribed in nearly 74% of outpatient visits. Chest x-rays were obtained in 43% of visits, despite guidelines against routine use for young children with pneumonia in an outpatient setting. Findings were published in the Journal of the Pediatric Infectious Diseases Society.

"It is concerning that so many young children with community-acquired pneumonia are receiving antibiotics that are not needed," Dr. Florin, who heads the Grainger Initiative in Pediatric Emergency Medicine Research at Lurie Children's and is Associate Professor of Pediatrics at Northwestern University Feinberg School of Medicine, said in a release. "In addition to going against evidence and clinical guidelines, overuse of antibiotics contributes to antibiotic resistance, which threatens future availability of effective treatments for bacterial infections, while also leading to antibiotic-associated side effects that can range from mild to life-threatening.

In 2011, clinical guidelines for pediatric community-acquired pneumonia were issued by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. These groups recommend against routine chest x-ray, complete blood count and blood cultures, as well as against routine antibiotics for preschool children treated as outpatients.

To evaluate the effect of this guideline, Florin and colleagues examined national data representing an estimated 6.3 million visits to outpatient clinics and emergency departments during 2008-2015 by children 1 to 6 years of age with community-acquired pneumonia. They found that high use of non-recommended diagnostic tests and antibiotics persisted over the entire study period, and that the 2011 guidelines had no impact on practice.

 

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