Antibiotic route and outcomes for children hospitalized with pneumonia

Background

Emerging evidence suggests that initial oral and intravenous (IV) antibiotics have similar efficacy in pediatric community-acquired pneumonia (CAP), but further data are needed.

Objective

We determined the association between hospital-level initial oral antibiotic rates and outcomes in pediatric CAP.

Designs, Settings, and Participants

This retrospective cohort study included children hospitalized with CAP at 43 hospitals in the Pediatric Health Information System (2016–2022). Hospitals were grouped by whether initial antibiotics were given orally in a high, moderate, or low proportion of patients.

Main Outcome and Measures

Regression models examined associations between high versus low oral-utilizing hospitals and length of stay (LOS, primary outcome), intensive care unit (ICU) transfers, escalated respiratory care, complicated CAP, cost, readmissions, and emergency department (ED) revisits.

Results

Initial oral antibiotics were used in 16% (interquartile range: 10%–20%) of 30,207 encounters, ranging from 1% to 68% across hospitals. Comparing high versus low oral-utilizing hospitals (oral rate: 32% [27%–47%] and 10% [9%–11%], respectively), there were no differences in LOS, intensive care unit, complicated CAP, cost, or ED revisits. Escalated respiratory care occurred in 1.3% and 0.5% of high and low oral-utilizing hospitals, respectively (relative ratio [RR]: 2.96 [1.12, 7.81]), and readmissions occurred in 1.5% and 0.8% (RR: 1.68 [1.31, 2.17]). Initial oral antibiotics varied across hospitals without a difference in LOS. While high oral-utilizing hospitals had higher escalated respiratory care and readmission rates, these were rare, the clinical significance of these small differences is uncertain, and there were no differences in other clinically relevant outcomes. This suggests some children may benefit from initial IV antibiotics, but most would probably do well with oral antibiotics.