The Influence of National Guidelines on the Management of Community-Acquired Pneumonia in Children. Do Pediatricians Follow the Recommendations?
- 359 Downloads
This is a retrospective study whose main objective was to analyze the influence of the Polish Guidelines for the Management of Respiratory Tract Infections of 2010 (PGMRTI) on in-hospital treatment of children with community-acquired pneumonia (CAP). Files from four Warsaw hospitals were reviewed to identify children with uncomplicated CAP, treated before (2008–2009) (pre-PGMRTI) and after (2011–2012) (post-PGMRTI) publication of the guidelines. Predefined data on the management were compared. A cohort of 2,359 children (1,081 pre-PGMRTI and 1,278 post-PGMRTI) was included. We found that co-amoxiclav was the most common first-line therapy in children >3 months of age (34.6% and 40.4% pre- and post-PGMRTI, respectively), followed by cefuroxime (31.8% and 20.9% pre- and post-PGMRTI, respectively; p < 0.0001) and macrolides (17.4% and 24.5% pre- and post-PGMRTI, respectively; p < 0.0001). Amoxicillin was rarely used (5.4% and 4.9%, pre- and post-PGMRTI, respectively). The study revealed an overuse of inhaled bronchodilators, corticosteroids, and mucoactive drugs. Blood diagnostic tests were applied to a significant percentage of patients: blood cultures (41.2% and 44.5% pre-and post-PGMRTI, respectively) and serology for atypical pathogens (27.9% and 44.9% pre-and post-PGMRTI, respectively; p < 0.0001). The number of follow-up chest X-rays increased (30.5% and 53.8% pre- and post-PGMRTI, respectively; p < 0.0001). In conclusion, the study demonstrates an unsatisfactory influence of the guidelines on in-hospital management of CAP in children. Despite an explicit recommendation for the use of amoxicillin, it was still underused. Other methods of education and guideline dissemination are needed to optimize the prescribing of antibiotics.
KeywordsAntibiotics Children Community-acquired pneumonia Guidelines Management Recommendations
Conflicts of Interest
The authors declare no conflicts of interest in relation to this article.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Bioethics Committee of Medical University of Warsaw, Poland. Since it is a retrospective study based on a review of patients’ files, the requirement of obtaining consent from individual study participants was waived.
- Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, Kaplan SL, Mace SE, McCracken GH Jr et al (2011) The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 53:e25–e76CrossRefGoogle Scholar
- Dean P, Florin TA (2018) Factors associated with pneumonia severity in children: a systematic review. J Pediatr Infect Dis Soc 7(4):323–334Google Scholar
- Deptuła A, Trejnowska E, Dubiel G, Deptuła M, Zienkiewicz M, Żukowska A, Misiewska-Kaczur A, Ozorowski T, Księżniakiewicz P, Kubiak J, Hryniewicz W (2018) Use of ECDC PPS HAI&AU data to evaluate adherence to national guidelines for antimicrobial treatment of community acquired pneumonia. Pol Arch Intern Med 128:209–215PubMedGoogle Scholar
- Hryniewicz W, Albrecht P, Radzikowski A (2016) Guidelines for the management of community-acquired respiratory tract infections. Recommendations of approach in respiratory tract infections. In: National Program of Antibiotics Protection, National Medicines Institute. https://www.antybiotyki.edu.pl/pdf/Rekomendacje2016.pdf. Accessed on 9 May 20119
- Ross RK, Hersh AL, Kronman MP, Newland JG, Metjian TA, Localio AR, Zaoutis TE, Gerber JS (2014) Impact of Infectious Diseases Society of America/Pediatric Infectious Diseases Society guidelines on treatment of community-acquired pneumonia in hospitalized children. Clin Infect Dis 58:834–838CrossRefGoogle Scholar
- Semczuk K, Dzierzanowska-Fangrat K, Lopaciuk U, Gabinska E, Jozwiak P, Dzierzanowska D (2004) Antimicrobial resistance of Streptococcus pneumoniae and Haemophilus influenzae isolated from children with community acquired respiratory tract infections in Central Poland. Int J Antimicrob Agents 23:39–43CrossRefGoogle Scholar
- WHO (2015) Global action plan on antimicrobial resistance. https://www.wpro.who.int/entity/drug_resistance/resources/global_action_plan_eng.pdf