Impact of a Guideline on Management of Children Hospitalized With Community-Acquired Pneumonia

Pediatrics. 2012 Mar;129(3):e597-604. doi: 10.1542/peds.2011-1533. Epub 2012 Feb 20.


Objectives: We sought to describe the impact a clinical practice guideline (CPG) had on antibiotic management of children hospitalized with community-acquired pneumonia (CAP).

Patients and methods: We conducted a retrospective study of discharged patients from a children's hospital with an ICD-9-CM code for pneumonia (480-486). Eligible patients were admitted from July 8, 2007, through July 9, 2009, 12 months before and after the CAP CPG was introduced. Three-stage least squares regression analyses were performed to examine hypothesized simultaneous relationships, including the impact of our institution\x{2019}s antimicrobial stewardship program (ASP).

Results: The final analysis included 1033 patients: 530 (51%) before the CPG (pre-CPG) and 503 (49%) after the CPG (post-CPG). Pre-CPG, ceftriaxone (72%) was the most commonly prescribed antibiotic, followed by ampicillin (13%). Post-CPG, the most common antibiotic was ampicillin (63%). The effect of the CPG was associated with a 34% increase in ampicillin use (P < .001). Discharge antibiotics also changed post-CPG, showing a significant increase in amoxicillin use (P < .001) and a significant decrease in cefdinir and amoxicillin/clavulanate (P < .001), with the combined effect of the CPG and ASP leading to 12% (P < 0.001) and 16% (P < .001) reduction, respectively. Overall, treatment failure was infrequent (1.5% vs 1%).

Conclusions: A CPG and ASP led to the increase in use of ampicillin for children hospitalized with CAP. In addition, less broad-spectrum discharge antibiotics were used. Patient adverse outcomes were low, indicating that ampicillin is appropriate first-line therapy for otherwise healthy children admitted with uncomplicated CAP.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Age Distribution
  • Anti-Bacterial Agents / administration & dosage*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Community-Acquired Infections / diagnosis
  • Community-Acquired Infections / drug therapy*
  • Community-Acquired Infections / epidemiology
  • Female
  • Follow-Up Studies
  • Hospitalization / statistics & numerical data
  • Humans
  • Incidence
  • Infant
  • International Classification of Diseases
  • Male
  • Pneumonia, Bacterial / diagnosis
  • Pneumonia, Bacterial / drug therapy*
  • Pneumonia, Bacterial / epidemiology
  • Practice Guidelines as Topic / standards*
  • Radiography, Thoracic
  • Reference Values
  • Retrospective Studies
  • Risk Assessment
  • Sex Distribution
  • Treatment Outcome


  • Anti-Bacterial Agents