Comparative Effectiveness of Empiric β-Lactam Monotherapy and β-Lactam-Macrolide Combination Therapy in Children Hospitalized with Community-Acquired Pneumonia

Objective To determine the comparative effectiveness of beta-lactam monotherapy and beta-lactam and macrolide combination therapy on clinical outcomes in the treatment of children hospitalized with community-acquired pneumonia (CAP). Study design This multicenter retrospective cohort study included children aged 1-18 years who were hospitalized with CAP and received beta-lactam antibiotic therapy either alone or in combination with a macrolide. Data were obtained from the Pediatric Health Information System. Associations between empiric antibiotic therapy and hospital readmission for the same episode of pneumonia were estimated using exact logistic regression. Associations between empiric antibiotic therapy and length of hospital stay were estimated using a generalized estimating equation with negative binomial distribution. Results There were 20 743 patients hospitalized with CAP. Of these, 24% received beta-lactam and macrolide combination therapy on admission. Compared with children who received beta-lactam monotherapy, children who received beta-lactam plus macrolide combination therapy were 20% less likely to stay in the hospital an additional day (adjusted relative risk 0.80; 95% CI, 0.75-0.86) but did not have a different readmission rate (relative risk 0.69; 95% CI, 0.41-1.12). An effect of combination treatment on reduced length of stay was not evident in children <6 years of age but increased with increasing age groups thereafter. Conclusion School-aged patients hospitalized with CAP who received beta-lactam plus macrolide combination therapy have a shorter length of stay and similar rates of readmission compared with school-aged patients who receive beta-lactam monotherapy. (J Pediatr 2012;161:1097-103).