Penicillin as effective as “big gun” antibiotics for treating less-severe childhood pneumonia

Children hospitalized for pneumonia have similar outcomes, including length of stay and costs, regardless of whether they are treated with “big gun” antibiotics such as ceftriaxone or cefotaxime or more narrowly focused antibiotics such as ampicillin or penicillin, according to a Vanderbilt study published in Pediatrics.

Study authors said the findings are important because pneumonia is 1 of the most common reasons for hospitalization among US children and because broad-spectrum antibiotics are frequently overprescribed, leading to antibiotic resistance.

“We have seen increases in use of broad spectrum antibiotics and concurrent increases in disease caused by resistant bacteria,” said lead author Derek J. Williams, MD, MPH, assistant professor of pediatrics.”The broad-spectrum antibiotics are frequently used to treat pneumonia due to concerns about drug-resistant organisms and the widely held perception that broader-spectrum agents result in more rapid recovery and may be ultimately cheaper because of less frequent dosing requirements,” he told Formulary.

In summer 2011, the Pediatric Infectious Diseases Society and Infectious Diseases Society of America (PIDS/IDSA) released joint community-acquired pneumonia guidelines that recommend narrow-spectrum antibiotic therapy for most children hospitalized with pneumonia but, until now, few studies had compared the effectiveness of this strategy relative to use of broad-spectrum antibiotics.

Vanderbilt researchers conducted a retrospective cohort study using data from the Pediatric Health Information System (PHIS) database (maintained by Children's Hospital Association), which contains detailed billing and resource utilization data from 43 free-standing US children's hospitals (which account for approximately 15% of annual pediatric hospitalizations in the United States).

They compared outcomes among more than 15,000 children aged 6 months to 18 years hospitalized for pneumonia between 2005 and 2011, receiving either ampicillin or penicillin (narrow spectrum) or a third generation cephalosporin (ceftriaxone or cefotaxime,[broad spectrum]).

According to the PIDS/IDSA guidelines, both treatment strategies are effective for disease caused by Streptococcus pneumoniae, the most common bacterial cause of pneumonia.

“The 2011 pneumonia guidelines supported the use of more narrow-spectrum agents, specifically ampicillin or penicillin but very few previous studies had directly compared the effectiveness of narrow (ampicillin or penicillin) versus broad (ceftriaxone or cefotaxime) spectrum therapies. We identified this as an important knowledge gap to address,” Dr Williams said.

“Our study demonstrated similar clinical outcomes and costs among children hospitalized with pneumonia treated with ampicillin or penicillin [narrow-spectrum antibiotics] versus ceftriaxone or cefotaxime [broad-spectrum],” he added. 

“Limiting unnecessary exposure to antibiotics in general and to broad-spectrum antibiotics in particular is important for minimizing the spread of antimicrobial drug resistance and to assure that those agents remain effective therapies,” said Carlos G. Grijalva, MD, MPH, assistant professor of Health Policy and senior author of the study. “Our study showed that clinical outcomes and costs were similar between narrow- and broad-spectrum antibiotic regimens. These findings are in line with the 2011 guidelines and support the preferential use of narrow spectrum antibiotics as first-line therapies for most children hospitalized with pneumonia.”

The researchers’ findings demonstrated similar hospital length of stay, admission to ICU and 14 days-readmission, and costs between narrow- and broad-spectrum antibiotic regimens for treatment of children hospitalized with pneumonia. “Importantly, nearly 90% of children with pneumonia received broad-spectrum therapy, compared with only 10% receiving narrow-spectrum therapy in our study,” Dr Williams said.

“This relative low use of narrow-spectrum antibiotics highlights a substantial opportunity to promote greater use of these effective regimens for treatment of children hospitalized with pneumonia.” added Dr Grijalva.

“Our data should reassure clinicians regarding the effectiveness of ampicillin or penicillin for most children hospitalized with pneumonia, allowing the broader-spectrum agents such as ceftriaxone or cefotaxime to be reserved for more severe cases and or drug-resistant infections.” Dr Williams concluded.