Ambulatory Visit Rates and Antibiotic Prescribing for Children with Pneumonia, 1994-2007

Fewer children are being hospitalized for community-acquired pneumonia (CAP) following introduction of the pneumococcal conjugate vaccine (PCV7) in 2007.

Narrow-spectrum antibiotics such as penicillins are the preferred class of drug for treating CAP, with even patients with pneumonia caused by penicillin-resistant pneumococci responding favorably. But most children treated in ambulatory settings for CAP receive broad-spectrum antibiotics, which are unnecessary and sometimes less effective. Broad-spectrum macrolides and cephalosporins are prescribed more often (34% and 22% respectively) than narrow-spectrum penicillins (14%).

In 2004–2007, some 1.2 million children were seen annually in ambulatory visits, 68 percent of whom received antibiotics, 84 percent of which were broad spectrum. For those 266,000 children seen annually in the emergency department, 86 percent received antibiotics, 76 percent of which were broad spectrum. Increasing age, evaluation in the office and obtaining a radiograph or complete blood count during the visit were associated with broad-spectrum antibiotic prescribing.

The unchanged rate of outpatient pediatric CAP diagnosis, despite the introduction of PCV7, suggests that better diagnoses are needed to distinguish bacterial from viral pneumonia. That, together with the establishment and use of guidelines for diagnosis and management of pediatric outpatient pneumonia, could decrease the overuse of broad-spectrum antibiotics.