Meds and you

22 February 2012

Guideline gets kids the right drug for pneumonia

After one hospital set guidelines for how to treat children with pneumonia, the number getting the right antibiotic shot up, a new study finds.


After one hospital set guidelines for how to treat children with pneumonia, the number getting the right antibiotic shot up, a new study finds.

Pneumonia refers to inflammation in the lungs caused by an infection. In babies and preschoolers, pneumonia is usually caused by a virus, and the infection goes away on its own.

Some children develop pneumonia caused by bacteria, however, and those cases are typically more serious -- with symptoms like high fever and breathing problems that require antibiotics and sometimes a stay in the hospital.

According to guidelines from the Infectious Disease Society of America (IDSA), most children hospitalised with bacterial pneumonia should get an older, penicillin-like antibiotic called ampicillin -- rather than newer, more powerful antibiotics that kill off a broad spectrum of bacteria.

Hospitals set own guidelines

But those guidelines were published just last year, so US hospitals have historically been on their own in coming up with treatment plans.

"There is a lot of variability," said Dr Jason G Newland, who worked on the new study.

His centre, Children's Mercy Hospital in Kansas City, Missouri, was ahead of the IDSA guidelines. In 2008, the hospital set its own guidelines saying that children with "uncomplicated" bacterial pneumonia should get ampicillin.

And, based on the new study, published in the journal Paediatrics, the move did change doctors' habits.

In the year before the guideline, just 13% of kids hospitalised with bacterial pneumonia were given ampicillin. That jumped to 63% in the year after the guideline took effect.

In contrast, during the pre-guideline year, 72% of kids received ceftriaxone (Rocephin), a newer "broad-spectrum" antibiotic.

Broad-spectrum antibiotics kill off a range of bacteria. The problem, Newland explained, is that overusing an antibiotic like ceftriaxone can lead to antibiotic resistance – which means the drug becomes ineffective against at least some of the bugs it's intended to kill.

Ampicillin, in contrast, is a narrow-spectrum drug that fights the most common cause of bacterial pneumonia in kids – Streptococcus pneumonia.

Yearly flu shots

And Newland's team found that the switch to ampicillin did not seem to do any harm.

In the pre-guideline year, 1.5% of 530 children had a treatment "failure" – meaning the pneumonia got worse and required more drugs or an invasive treatment. That rate was one percent in the year after the guideline took hold.

"There has been a fear, 'Is the ampicillin not going to be good enough?'" Newland said.

But this study helps confirm that ampicillin is safe and effective for kids' pneumonia, Newland's team says.

"And it gives credence to the new national (IDSA) guidelines," Newland said.

As for why ceftriaxone had been the hospital's antibiotic of choice before, Newland said he suspects it was at least partly because the drug is easy to use. It only has to be given once a day, which makes it a common choice in paediatrics.

But guidelines like the IDSA's are aimed at getting more patients the antibiotics that are most effective, safest and least likely to feed the larger problem of antibiotic resistance.

"We are trying to standardise these things to improve the quality of care," Newland said.

For parents, he noted, the findings are a reminder that newer and more powerful does not always mean better.

"Some people ask for newer antibiotics," Newland said. "There's a feeling that bigger is better. But these antibiotics (like ampicillin) are good because they're narrower in focus."

Parents can also help protect their kids from developing pneumonia in the first place, the IDSA stresses. Kids, like adults, often develop bacterial pneumonia after a viral infection, including the flu.

So it's important, the IDSA says, for children ages six months and older to have a yearly flu shot, and to be up-to-date with all the recommended vaccinations.

(Amy Norton, Reuters Health, February 2012)

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