Original ArticleAntibiotic Choice and Clinical Outcomes in Ambulatory Children with Community-Acquired Pneumonia
Section snippets
Methods
This was a retrospective cohort study using the IBM Watson Health MarketScan Medicaid database (IBM Corporation, Somers, New York), a proprietary Medicaid claims database from 11 deidentified, geographically diverse states that allows for longitudinal tracking of enrollees over time through a variety of healthcare settings. This study was determined to be exempt from human subjects research by the Institutional Review Board at the study institution.
Results
Over the 7-year study period, 455 704 children were discharged from an ambulatory care setting with a diagnosis of community-acquired pneumonia. After exclusions, our final cohort consisted of 252 177 children, among whom 91 482 (36.3%) were treated in the ED and 160 695 (63.7%) were treated in an outpatient clinic (Figure 1; available at www.jpeds.com). The median patient age was 4 years (IQR, 2-7 years) (Table I). Overall, 57 565 children (22.8%) had a history of asthma and 34 104 (13.5%) had
Discussion
In this retrospective cohort study of >250 000 Medicaid-insured children, we found that a substantial portion of children treated for community-acquired pneumonia in the ambulatory setting received broad-spectrum antibiotics or macrolides. This pattern persists several years after publication of national guidelines emphasizing the use of narrow-spectrum aminopenicillins in children with nonsevere community-acquired pneumonia, although we did observe an increase in narrow-spectrum antibiotic use
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C.G. was supported in part by the National Institutes of Health (NIAID K24AI148459). The other authors declare no conflicts of interest.