By Ethan Covey
The treatment of community-acquired pneumonia (CAP) in children presents significant antibiotic stewardship challenges, according to a recent study.
Children with mild CAP commonly receive antibiotics, even though their infections are often viral. However, barriers to lessened antibiotic prescribing exist among parents and healthcare professionals, the study found (Pediatrics 2024 Jan 18. https://doi.org/10.1542/peds.2023-063782).
“This is a problem because we know that unnecessary antibiotics can cause harm,” said lead author, Julia E. Szymczak, PhD, an associate professor at the University of Utah School of Medicine, in Salt Lake City. “We also know that stopping widely used, but unnecessary treatments is challenging.”
The study aimed to understand how antibiotics are used to treat young children with pneumonia in the outpatient setting. Interviews were conducted from January to July 2021 with parents of young children who had been diagnosed with mild CAP in the previous three years, and clinicians practicing in outpatient settings at a large U.S. pediatric hospital. Eighteen parents and 20 clinicians responded.
None of the parents and 55% of the clinicians were aware of a “no antibiotic” strategy for CAP that existed at the hospital. While parent views varied, generally they could be categorized into three beliefs about the idea: positive, mixed and negative.
Those in the positive category understood that there were drawbacks to using medications when not needed, trusted their clinicians and were confident that follow-up treatment could be coordinated if needed.
Mixed views focused on tensions between trust in science versus emotions related to the need to care for a sick child. Many parents also were uncomfortable with not receiving antibiotics, because the current treatment seemed different from past experiences with pneumonia. This barrier resulted in believing that a clinician could be withholding treatment.
Parents with negative beliefs largely felt that pneumonia always required antibiotic therapy, disagreed with the categorization that their children’s symptoms were mild and perceived risks associated with antibiotics as acceptable.
When asked what makes it difficult to not prescribe antibiotics for outpatient children with CAP, clinicians cited several factors, including diagnostic uncertainty, fear of consequences associated with delaying treatment, cultural norms regarding pneumonia, parent expectations and a tolerance for the risk associated with excess antibiotic use.
“While our respondents were broadly supportive of using antibiotics judiciously, treating CAP in the outpatient setting presents a number of challenges for stewardship, related to emotional, social and contextual barriers,” Dr. Szymczak said. “Interventions to de-implement antibiotics for CAP in the outpatient setting should address these challenges through things like communication training and multifaceted de-implementation interventions to modify norms.”
Dr. Szymczak reported no relevant financial disclosures.
