Impact assessment of a decision rule for using antibiotics in pneumonia: A randomized trial

• Published in: Pediatric pulmonology Vol. 49; no. 7; pp. 701 - 706
• Main Authors: Torres, Fernando A., Pasarelli, Irma, Cutri, Adrián, Ossorio, María F., Ferrero, Fernando
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-07-2014; Wiley Subscription Services, Inc
• Subjects: acute respiratory infection; Anti-Bacterial Agents - therapeutic use; Antibiotics; Child, Preschool; Decision Support Techniques; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Infant; Male; Pneumonia; Pneumonia, Bacterial - diagnosis; Pneumonia, Bacterial - drug therapy; Pneumonia, Viral - diagnosis; Single-Blind Method; Treatment Outcome; pneumonia; acute respiratory infection; decision-support techniques
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.22849

Background
Although more than half of the cases of pneumonia in children can be due to virus, most of them receive antibiotic treatment. A previously published clinical prediction rule bacterial pneumonia score (BPS) allows the identification of children with pneumonia who do not require antibiotics, but its impact has not been evaluated. We assessed whether the use of the BPS for the initial management of patients with pneumonia results in decreasing the use of antibiotics than under standard management of this condition without increasing patients' risks.
Methods
This was a randomized, parallel‐group, observer‐blind, controlled clinical trial comparing the use of antibiotics in children aged 3–60 months treated for pneumonia in an outpatient setting, according to two methods of initial management. Patients were assigned randomly to management according to the BPS (antibiotic indication with a BPS ≥ 4 points) or routine management (antibiotic indication based on the institutional guidelines). We calculated the proportion of the use of antibiotics in each group and evaluated each patient's clinical outcome.
Results
We included 120 patients (60 BPS and 60 controls) with a mean age of 24.2 ± 14.1 months. The use of antibiotics was significantly lower in the BPS group (46.6% vs. 86.6; OR 0.13; 95% CI: 0.05–0.35; P < 0.001). We observed an unfavorable outcome in 10 patients (8.3%), 5 in each group (P = 1.0; OR: 1.0 95% CI: 0.2–3.6).
Conclusion
The use of antibiotics was significantly lower in the group managed according to the BPS compared to the conventionally treated group, without increasing the rate of treatment failure. Pediatr Pulmonol. 2014; 49:701–706. © 2013 Wiley Periodicals, Inc.