Advertisement

The Influence of National Guidelines on the Management of Community-Acquired Pneumonia in Children. Do Pediatricians Follow the Recommendations?

  • Grażyna Kraj
  • Joanna PeradzyńskaEmail author
  • Julita Chądzyńska
  • Marek Kulus
  • Krystian Wołoszyn
  • Teresa Jackowska
  • Maria Krajewska
  • Anna Mołdoch-Łukasik
  • Agnieszka Czubik-Przybyła
  • Aneta Górska-Kot
  • Katarzyna Krenke
Chapter
First Online:
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1211)

Abstract

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.

Keywords

Antibiotics Children Community-acquired pneumonia Guidelines Management Recommendations 
This is a preview of subscription content, log in to check access.

Notes

Conflicts of Interest

The authors declare no conflicts of interest in relation to this article.

Ethical Approval

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.

References

  1. Black SB, Shinefield HR, Ling S, Hansen J, Fireman B, Spring D, Noyes J, Lewis E, Ray P, Lee J, Hackell J (2002) Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than five years of age for prevention of pneumonia. Pediatr Inect Dis J 21:810–815CrossRefGoogle Scholar
  2. Bowen SJ, Thomson AH (2013) British Thoracic Society Paediatric Pneumonia Audit: a review of 3 years of data. Thorax 68:682–683CrossRefGoogle Scholar
  3. 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
  4. Cunha BA (2004) Therapeutic implications of antibacterial resistance in community-acquired respiratory tract infections in children. Infection 32:98–108CrossRefGoogle Scholar
  5. Davey P, Marwick CA, Scott CL, Charani E, McNeil K, Brown E, Gould IM, Ramsay CR, Michie S (2017) Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2:CD003543PubMedGoogle Scholar
  6. 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
  7. 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
  8. Dona D, Zingarella S, Gastaldi A, Lundin R, Perilongo G, Frigo AC, Hamdy RF, Zaoutis T, Da Dalt L, Giaquinto C (2018) Effects of clinical pathway implementation on antibiotic prescriptions for pediatric community-acquired pneumonia. PLoS One 13:e0193581CrossRefGoogle Scholar
  9. Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M, Thomson A (2011) British Thoracic Society guidelines for the management of community-acquired pneumonia in children: update 2011. Thorax 66(Suppl 2):ii1–ii23CrossRefGoogle Scholar
  10. Heath PT (2000) Epidemiology and bacteriology of bacterial pneumonias. Paediatr Respir Rev 1:4–7PubMedGoogle Scholar
  11. 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
  12. Korppi M (2004) Nonspecific host response markers in the differentiation between pneumococcal and viral pneumonia: what is the most accurate combination? Pediatr Int 46:545–550CrossRefGoogle Scholar
  13. Kreitmeyr K, von Both U, Pecar A, Borde JP, Mikolajczyk R, Huebner J (2017) Pediatric antibiotic stewardship: successful interventions to reduce broad-spectrum antibiotic use on general pediatric wards. Infection 45:493–504CrossRefGoogle Scholar
  14. Nohynek H, Valkeila E, Leinonen M, Eskola J (1995) Erythrocyte sedimentation rate, white blood cell count and serum C-reactive protein in assessing etiologic diagnosis of acute lower respiratory infections in children. Pediatr Inect Dis J 14:484–490CrossRefGoogle Scholar
  15. Principi N, Esposito S (2018) Emerging problems in the treatment of pediatric community-acquired pneumonia. Expert Rev Respir Med 12:595–603CrossRefGoogle Scholar
  16. 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
  17. Schroeder MR, Stephens DS (2016) Macrolide resistance in Streptococcus pneumoniae. Front Cell Infect Microbiol 6:98CrossRefGoogle Scholar
  18. 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
  19. Skoczyńska A, Kadłubowski M, Waśko I, Fiett J, Hryniewicz W (2007) Resistance patterns of selected respiratory tract pathogens in Poland. Clin Microbiol Infect 1:377–383CrossRefGoogle Scholar
  20. Smith MJ, Kong M, Cambon A, Woods CR (2012) Effectiveness of antimicrobial guidelines for community-acquired pneumonia in children. Pediatrics 129:e1326–e1333CrossRefGoogle Scholar
  21. Virkki R, Juven T, Rikalainen H, Svedstrom E, Mertsola J, Ruuskanen O (2002) Differentiation of bacterial and viral pneumonia in children. Thorax 57:438–441CrossRefGoogle Scholar
  22. WHO (2015) Global action plan on antimicrobial resistance. https://www.wpro.who.int/entity/drug_resistance/resources/global_action_plan_eng.pdf
  23. Williams DJ, Hall M, Gerber JS, Neuman MI, Hersh AL, Brogan TV, Parikh K, Mahant S, Blaschke AJ, Shah SS, Grijalva CG (2017) Impact of a national guideline on antibiotic selection for hospitalized pneumonia. Pediatrics 139:pii: e20163231CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Grażyna Kraj
    • 1
  • Joanna Peradzyńska
    • 2
    Email author
  • Julita Chądzyńska
    • 1
  • Marek Kulus
    • 1
  • Krystian Wołoszyn
    • 3
  • Teresa Jackowska
    • 3
    • 4
  • Maria Krajewska
    • 5
  • Anna Mołdoch-Łukasik
    • 5
  • Agnieszka Czubik-Przybyła
    • 6
  • Aneta Górska-Kot
    • 6
  • Katarzyna Krenke
    • 1
  1. 1.Department of Pediatric Pneumology and AllergyMedical University of WarsawWarsawPoland
  2. 2.Department of Epidemiology and BiostatisticsMedical University of WarsawWarsawPoland
  3. 3.Department of PediatricsBielanski HospitalWarsawPoland
  4. 4.Department of PediatricCenter of Postgraduate Medical EducationWarsawPoland
  5. 5.Department of Pediatrics and EndocrinologyMedical University of WarsawWarsawPoland
  6. 6.Department of PediatricsChildren’s HospitalWarsawPoland

Personalised recommendations

Cite chapter

Buy options