Abstract
BACKGROUND: Although viral etiologies predominate, antibiotics are frequently prescribed for community-acquired pneumonia (CAP). OBJECTIVE: We evaluated the association between antibiotic use and outcomes among children hospitalized with suspected CAP. DESIGNS, SETTINGS AND PARTICIPANTS: We performed a secondary analysis of a prospective cohort of children hospitalized with suspected CAP. INTERVENTION: The exposure was the receipt of antibiotics in the emergency department (ED). MAIN OUTCOME AND MEASURES: Clinical outcomes included length of stay (LOS), care escalation, postdischarge treatment failure, 30-day ED revisit, and quality-of-life (QoL) measures from a follow-up survey 7-15 days post discharge. To minimize confounding by indication (e.g., radiographic CAP), we performed inverse probability treatment weighting with propensity analyses. RESULTS: Among 523 children, 66% were <5 years, 88% were febrile, 55% had radiographic cap, and 55% received ed antibiotics. the median los was 41 h (iqr: 25, 54). after propensity analyses, there were no differences in los, escalated care, treatment failure, or revisits between children who received antibiotics and those who did not. seventy-one percent of patients completed follow-up surveys after discharge. among 16% of patients with fevers after discharge, the median fever duration was 2 days, and those who received antibiotics had a 37% decrease in the mean number of days with fever (95% confidence interval: 20% and 51%). we found no statistical differences in other qol measures.>
