There’s an interesting cultural phenomenon regarding inpatient treatment of respiratory illnesses – a sense that monitoring and close evaluation for treatment failure isn’t enough, and we must immediately deploy the nuclear option when the admission decision is made. This includes nonsense use of intravenous administration when oral is equivalent and unnecessary use of broad-spectrum agents.
This comparative-effectiveness study evaluated the necessity of broad-spectrum agents versus narrow-spectrum antibiotics for the treatment of pediatric community-acquired pneumonia. 492 CAP admissions from four children’s hospitals in 2010 were retrospectively reviewed for outcomes, stratified by antibiotic choice. Narrow-spectrum antibiotic choices were penicillin-like agents +/- macrolide, while broad-spectrum included cephalosporins or fluoroquinolones.
In their propensity-matched cohort, with the acknowledged limitations of unmeasured baseline characteristics, there were no useful differences in outcomes. Most trends favored narrow-spectrum antibiotics, but these are at best statistical noise, and at worst reflect underlying unmatched treatment-episode confounders.
Current consensus-based recommendations are for initial treatment with narrow-spectrum agents – follow them. I’d also note 51% of the population received blood cultures – 2.8% of which were positive. I’m sure these were also entirely a waste of money.
“Comparative Effectiveness of Empiric Antibiotics for Community-Acquired Pneumonia”
http://www.ncbi.nlm.nih.gov/pubmed/24324001
Am I in the only group left that does sputum samples? Granted, many are "normal resp flora", but when saved for truly productive cough have been very helpful for choosing bigger guns when needed. Harder with the kiddos, but frequently an adult in the house has the same infection so I use them as a proxy.
IV, nuclear blast Abx are never the norm here, and our patients live long healthy lives.
Not sure about sputum samples. As much a proponent of "culture the source" I am, I'm not sure the sensitivity or specificity of sputum. I tend to think you're going to end up with a lot of "mixed respiratory flora" false negatives or colonization false positives (especially if you're culturing an adult in the home!)