Choosing Wisely:

Don’t treat uncomplicated community-acquired pneumonia in otherwise healthy, immunized, hospitalized patients with antibiotic therapy broader than ampicillin.

Rationale and Comments: Community-acquired pneumonia (CAP) accounts for a significant percentage of antibiotic use in children. Unnecessary use of broad-spectrum antibiotics, including cephalosporins such as ceftriaxone, have been shown to contribute to antibiotic resistance and C. difficile infection. The most common cause of CAP in healthy, immunized children is Streptococcus pneumoniae, of which most strains are highly susceptible to penicillin/ampicillin. As ampicillin achieves high levels in the lung and is narrow in spectrum, it should be used as a first-line drug for inpatient management of most children with uncomplicated pediatric CAP. In cases with more resistant local epidemiology, or complicated CAP including empyema, antibiotics with a broader spectrum may be needed.
Sponsoring Organizations:
  • American Academy of Pediatrics – Committee on Infectious Diseases and the Pediatric Infectious Diseases Society
  • Sources:
  • IDSA guideline
  • Disciplines:
  • Pediatric
  • Pulmonary medicine
  • Infectious disease
  • References: • Bradley, JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, et al. (2011, October). 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. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. Oxford University Press. http://doi.org/10.1093/cid/cir531.
    • Newman RE, Hedican EB, Herigon JC, Williams DD, Williams AR, Newland JG. (2012). Impact of a Guideline on Management of Children Hospitalized With Community-Acquired Pneumonia. Pediatrics, 129(3), e597–e604. http://doi.org/10.1542/peds.2011-1533.
    • Harrison CJ, Woods C, Stout G, et al. Susceptibilities of Haemophilus influenzae, Streptococcus pneumoniae, including serotype 19A, and Moraxella catarrhalis paediatric isolates from 2005 to 2007 to commonly used antibiotics. J Antimicrob Chemother. 2009;63:511–9.
    • Kyaw MH, Lynfield R, Schaffner W, et al. Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. N Engl J Med.2006; 354:1455–63.

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