Antibiotic use and outcomes among children hospitalized with suspected pneumonia

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.