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Diagnostic Testing, Antibiotics Overused in Pediatric CAP

Chest radiography ordered in 43 percent, antibiotics prescribed in 73.9 percent of community-acquired pneumonia visits

TUESDAY, June 11, 2019 (HealthDay News) — Children with community-acquired pneumonia (CAP) often receive diagnostic testing and antibiotic therapy despite publication of guidelines against their routine use in 2011, according to a study published online May 20 in the Journal of the Pediatric Infectious Diseases Society.

Todd A. Florin, M.D., from Ann and Robert H. Lurie Children’s Hospital of Chicago, and colleagues performed a cross-sectional study using nationally representative data for visits to outpatient clinics and emergency departments for children aged 1 to <6 years with CAP. The frequency of diagnostic testing and antibiotic therapy use was examined before and after the 2011 publication of pediatric CAP guidelines recommending against routinely performing testing and providing antimicrobial therapy.

Data were included for 601 children from 2008 to 2015, representing an estimated 6.3 million pediatric CAP visits. The researchers found that a complete blood count, chest radiography, and blood culture were ordered in 8.6, 43, and 11.1 percent of cases, respectively. Antibiotics were prescribed in 73.9 percent of visits; at most visits, a second-line broad-spectrum antibiotic was prescribed. There was no difference in diagnostic test ordering or antibiotic orders overall or according to antibiotic class between the preguideline and postguideline periods.

“Focused quality-improvement efforts are needed to increase guideline adherence to ensure that these children are receiving appropriate, evidence-based care,” Florin said in a statement. “We especially need to focus on reducing antibiotic overuse, which is critically important.”

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