Children aged 6 years with community-acquired pneumonia who were receiving a ?-lactam and a macrolide had shorter hospital stays than those receiving a ?-lactam alone.

Experts disagree as to whether single (?-lactam only) antibiotic treatment is optimal for children hospitalized with community-acquired pneumonia (CAP) or whether adding a macrolide is preferable. (Study findings regarding adults vary, but some favor combination therapy.) In a recent Infectious Diseases Society of America guideline, ?-lactam monotherapy is recommended. To explore this issue further, researchers used data from 38 freestanding tertiary care children's hospitals, obtained from the Pediatric Health Information System.

The retrospective cohort study involved children aged 1 to 18 years with CAP who were discharged between 2006 and 2008. Treatment (single or combination therapy) was determined by antibiotic use on the first hospital day. The ?-lactams received were aminopenicillins, penicillin, and second- and third-generation cephalosporins; the macrolides were erythromycin, clarithromycin, and azithromycin. Children receiving other classes of antibiotics were excluded, as were those with severe pneumonia.

In all, 20,743 children were included — 15,809 who received a ?-lactam only and 4934 who received combination therapy. The use of combination therapy varied greatly among hospitals (17% to 48%); the most common antibiotic class, with or without a macrolide, was third-generation cephalosporins. Median length of stay (LOS) was 2 days for each group. However, after adjustment for risk factors, the LOS was 20% less for the combination-therapy group. The benefit was greatest for those aged 12 to 18 years and was not significant for those aged 1 to 5.

CITATION(S):

Ambroggio L et al. Comparative effectiveness of empiric ?-lactam monotherapy and ?-lactam–macrolide combination therapy in children hospitalized with community-acquired pneumonia. J Pediatr 2012 Dec; 161:1097.