Comparative effectiveness of ceftriaxone in combination with a macrolide relative to ceftriaxone alone for pediatric patients hospitalized with community acquired pneumonia.
Leyenaar, JoAnna.
2013
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Abstract: Community acquired pneumonia is the leading cause of pediatric hospitalization in the United States, with Mycoplasma pneumonaie thought to be a causative organism in up to one third of cases. National guidelines recommend empiric combination therapy with a macrolide and beta-lactam antibiotic for patients in whom infection with M. pneumoniae is a significant consideration. However, evide... read morence to support this recommendation is limited. The objectives of this study were to: (i) determine the effectiveness of ceftriaxone alone compared to ceftriaxone with a macrolide for the treatment of pneumonia among hospitalized children as measured by length of hospital stay, and; (ii) explore differences in total costs of hospitalization. We conducted a retrospective cohort study of children 1-17 years of age with pneumonia. Poisson regression was used to assess for associations between antibiotic regimen and length of stay, adjusting for patient and hospital characteristics and initial tests and therapies. Multivariable linear regression models were used to assess the log-treatment costs associated with each antibiotic regimen. A propensity score model to predict initial antibiotic therapy was constructed. A total of 13,493 children were included in the analysis, including 4701 who received ceftriaxone in combination with a macrolide and 8892 who received ceftriaxone alone. Among children 1-4 years of age, adjusted models revealed no significant difference in length of hospital stay, with total hospital costs significantly higher among those receiving combination therapy (cost ratio 1.04 (95% CI, 1.01-1.07)). Among children 5-17 years of age, children receiving combination therapy had a shorter adjusted length of stay (RR 0.95 (95% CI,0.92-0.98)), with no significant difference in total hospital costs (cost ratio 1.01 (95% CI, 0.98-1.04)). The addition of a macrolide does not appear to offer an advantage over ceftriaxone alone among preschool aged children with respect to length of hospital stay. Among children 5-17 years of age, empiric treatment of pneumonia with ceftriaxone in combination with a macrolide was associated with shorter length of hospital stay, equivalent to a need to treat seven children with combination therapy to result in one child staying in hospital for one less day.
Thesis (M.S.)--Tufts University, 2013.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: Peter Lindenauer.
Committee: Laurel Leslie, and Penelope Pekow.
Keywords: Epidemiology, Medicine, and Health sciences.read less - ID:
- 1n79hg810
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