Ambulatory visit rates and antibiotic prescribing for children with pneumonia, 1994-2007

Abstract

Background: The incidence of pediatric hospitalizations for community-acquired pneumonia (CAP) has declined after the widespread use of the heptavalent pneumococcal conjugate vaccine. The national incidence of outpatient visits for CAP, however, is not well established. Although no pediatric CAP treatment guidelines are available, current data support narrow-spectrum antibiotics as the first-line treatment for most patients with CAP.

Objective: To estimate the incidence rates of outpatient CAP, examine time trends in antibiotics prescribed for CAP, and determine factors associated with broad-spectrum antibiotic prescribing for CAP.

Patients and methods: The National Ambulatory and National Hospital Ambulatory Medical Care Surveys (1994-2007) were used to identify children aged 1 to 18 years with CAP using a validated algorithm. We determined age group-specific rates of outpatient CAP and examined trends in antibiotic prescribing for CAP. Data from 2006-2007 were used to study factors associated with broad-spectrum antibiotic prescribing.

Results: Overall, annual CAP visit rates ranged from 16.9 to 22.4 per 1000 population, with the highest rates occurring in children aged 1 to 5 years (range: 32.3-49.6 per 1000). Ambulatory CAP visit rates did not change between 1994 and 2007. Antibiotics commonly prescribed for CAP included macrolides (34% of patients overall), cephalosporins (22% overall), and penicillins (14% overall). Cephalosporin use increased significantly between 2000 and 2007 (P = .002). Increasing age, a visit to a nonemergency department office, and obtaining a radiograph or complete blood count were associated with broad-spectrum antibiotic prescribing.

Conclusions: The incidence of pediatric ambulatory CAP visits has not changed significantly between 1994 and 2007, despite the introduction of heptavalent pneumococcal conjugate vaccine in 2000. Broad-spectrum antibiotics, particularly macrolides, were frequently prescribed despite evidence that they provide little benefit over penicillins.

FIGURE 1

Two-yearly community-acquired pneumonia rates by age group. *Estimate for the 11- to 18-year-old age group contains fewer than 30 unadjusted records.

FIGURE 2

Antibiotic prescribing for community-acquired pneumonia, 1994–2007. *Estimate for penicillin in 1996–1997 and 1998–1999 contains fewer than 30 unadjusted records.