Abstract
IMPACT OF INFECTIOUS DISEASES SOCIETY OF AMERICA / PEDIATRIC INFECTIOUS DISEASES SOCIETY GUIDELINES ON ANTIBIOTIC CHOICE FOR HOSPITALIZED CHILDREN WITH COMMUNITY-ACQUIRED PNEUMONIA AT MAKASSED GENERAL HOSPITAL

*Nisrin Ghalayini, Amal Naous, Soha Ghanem, Samar Shaheen and Mariam Rajab

ABSTRACT

Background: In 2011 the Pediatrics Infectious Disease Society and the Infectious Disease Society of America (PIDS/IDSA) issued new guidelines regarding management and treatment of community-acquired pneumonia (CAP) emphasizing the use of narrow-spectrum antibiotic therapy as an empiric treatment for hospitalized children with CAP. Objectives: We assessed the impact of the 2011 PIDS/IDSA guidelines on antibiotic prescription for children hospitalized with community-acquired pneumonia at Makassed General Hospital (MGH). Methods: This retrospective chart review study included children 3 months to 18 years of age, hospitalized with clinical and radiographic evidence of CAP from December 1, 2005, through November 30, 2017, at Makassed General Hospital, Beirut, Lebanon, which is a tertiary care center. The study period was divided into pre-implementation and post-implementation periods, each over 6 years interval. We compared the impact of the 2011 PIDS/IDSA guidelines on antibiotic prescription for children hospitalized with CAP at MGH. Results: Overall, 1449 children were included. In the pre-implementation period, 905 patients were discharged from MGH with a diagnosis of CAP, with a significant decrease to 544 patients in the post-implementation period. During the pre-implementation period, 22.4% of children with CAP received third-generation cephalosporins, whereas this percentage decreased to 13.6% in the post-implementation period (p < 0.0001). However, the percentage of children who received amoxicillin-clavulanic acid in the pre-implementation period was 53.5% and increased to 66.2% in the post-implementation period (p < 0.0001). Macrolide monotherapy was common in both, pre-implementation (30.1%) and post-implementation (39%) guideline periods (P < 0.0001). Concurrent use of macrolide with amoxicillin-clavulanic acid increased significantly to 24.2% (p < 0.0001). Conclusion: After implementation of guidelines, third-generation cephalosporin use declined and penicillin/ampicillin/amoxicillin-clavulanic acid use increased among children hospitalized with CAP.

Keywords: Community-acquired pneumonia, antibiotics, antibiotics stewardship, antimicrobial, pediatrics, hospitalization, guidelines, prescription.


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