Comparative effectiveness of ceftriaxone in combination with a macrolide relative to ceftriaxone alone for pediatric patients hospitalized with community acquired pneumonia.
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, ... read moreevidence 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