480. Comparative Effectiveness of Beta-lactam Monotherapy with Macrolide Monotherapy in Children with Community-Acquired Pneumonia (CAP) in the Outpatient Setting
Session: Poster Abstract Session: Pediatric Infections: Bacterial and Parasite
Thursday, October 18, 2012
Room: SDCC Poster Hall F-H
Posters
  • Ambroggio IDWeek Poster_08October2012.pdf (429.4 kB)
  • Background: PIDS/ IDSA CAP guidelines recommend beta-lactam monotherapy as first line therapy. These guidelines are based on evidence from a limited number of studies. Macrolide monotherapy is often prescribed in the outpatient setting. The objective of this study is to compare the effectiveness of empiric therapy in children with CAP diagnosed in the outpatient setting.

    Methods: Children, 1-18 years old, with a clinical diagnosis of CAP at an outpatient practice affiliated with Geisinger Health System during January 1, 2008 to December 31, 2009 were eligible. The primary exposure was receipt of beta-lactam or macrolide monotherapy. The primary outcome was an unscheduled follow-up visit (i.e. outpatient, emergency department, or admitted as an inpatient) within 1-5 days of diagnosis.  Propensity scores were used to determine the likelihood of receiving macrolide monotherapy. Treatment groups were matched 1:1, based on propensity score and asthma status. Multivariable logistic regression models estimated the association between macrolide monotherapy and unscheduled follow-up visits.

    Results:   Of 1,999 children with CAP, 1,190 (60%) were matched. The median age of the matched cohort was 5 years old, interquartile range 3-8. In the matched cohort, 595 children were in each treatment group, 25% of children had asthma and 22% presented with wheezing. Patients who received macrolide monotherapy had lower odds of having an unscheduled follow-up visit compared with patients who received beta-lactam monotherapy. When the cohort was stratified by age group, children who were preschool age and younger had similar odds regardless of treatment whereas children who were school age or older who received macrolide monotherapy were less likely to have an unscheduled follow-up when compared to older children who received beta-lactam monotherapy (Figure 1).

    Conclusion: If unscheduled follow-up visits are considered a proxy for treatment failure then our findings suggest that school aged but not pre-school aged children diagnosed with CAP in the outpatient setting are less likely to fail treatment when treated with macrolide monotherapy.

    Lilliam Ambroggio, PhD, MPH1, Matthew Test2, Joshua Metlay, MD PhD3, Thomas Graf, MD4, Mary Ann Blosky, MSRN, MHA4, Maurizio Macaluso, MD, DrPH5 and Samir Shah, MD, MSCE1, (1)Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (2)Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinati, OH, (3)University of Pennsylvania School of Medicine, Philadelphia, PA, (4)Geisinger Center for Health Research, Danville, PA, (5) Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

    Disclosures:

    L. Ambroggio, None

    M. Test, None

    J. Metlay, None

    T. Graf, None

    M. A. Blosky, None

    M. Macaluso, None

    S. Shah, None

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