Abstract
OBJECTIVES: Preschool-aged children with mild community-acquired pneumonia (CAP) routinely receive antibiotics even though most infections are viral. We sought to identify barriers to the implementation of a “no antibiotic” strategy for mild CAP in young children. METHODS: Qualitative study using semistructured interviews conducted in a large pediatric hospital in the United States from January 2021 to July 2021. Parents of young children diagnosed with mild CAP in the previous 3 years and clinicians practicing in outpatient settings (pediatric emergency department, community emergency department, general pediatrics offices) were included. RESULTS: Interviews were conducted with 38 respondents (18 parents, 20 clinicians). No parent heard of the no antibiotic strategy, and parents varied in their support for the approach. Degree of support related to their desire to avoid unnecessary medications, trust in clinicians, the emotional difficulty of caring for a sick child, desire for relief of suffering, willingness to accept the risk of unnecessary antibiotics, and judgment about the child’s illness severity. Eleven (55%) clinicians were familiar with guidelines specifying a no antibiotic strategy. They identified challenges in not using antibiotics, including diagnostic uncertainty, consequences of undertreatment, parental expectations, follow-up concerns, and acceptance of the risks of unnecessary antibiotic treatment of many children if it means avoiding adverse outcomes for some children. CONCLUSIONS: Although both parents and clinicians expressed broad support for the judicious use of antibiotics, pneumonia presents stewardship challenges. Interventions will need to consider the emotional, social, and logistical aspects of managing pneumonia, in addition to developing techniques to improve diagnosis.
Original language | English (US) |
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Article number | e2023063782 |
Journal | Pediatrics |
Volume | 153 |
Issue number | 2 |
DOIs | |
State | Published - Feb 1 2024 |
Funding
FUNDING: Supported by National Heart Lung and Blood Institute grant R34HL153474 to Dr Florin. During the project period, Drs Szymczak and Gerber received support from a Centers for Disease Control and Prevention Cooperative Agreement #FOA#CK16-004-Epicenters for the Prevention of Healthcare Associated Infections. The funder had no role in the design or conduct of this study.
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health