Antibiotic Use and Outcomes in Young Children Hospitalized with Uncomplicated Community-Acquired Pneumonia

Objectives: To compare children aged 36 months or younger hospitalized with uncomplicated community-acquired pneumonia (CAP) that are not treated with antibiotics to those treated with antibiotics in terms of clinical features and outcome measures. Methods: Administrative data and medical record review were used to identify patients from 3-36 months of age hospitalized from 2011-2019 with uncomplicated CAP. Patients were considered treated if they received antibiotics for more than 2 inpatient days and/or at discharge, and not treated if they received 2 or fewer inpatient days and no antibiotics at discharge. Demographic features, clinical characteristics, radiologic findings, viral testing, illness severity, length of stay and 30-day hospital readmissions were assessed and compared according to antibiotic treatment. Results: 322 CAP cases were included. 266/322 (83%) received antibiotics for more than 48 hours and/or at discharge. 56 patients received 2 or fewer inpatient days of antibiotics and no antibiotics at discharge; the majority received no inpatient antibiotics. There were no differences between the two groups in illness severity, length of stay or hospital readmissions. The proportion of patients treated with antibiotics decreased from 88% (2011-2013) to 66% during the most recent years studied (2017-2019). Conclusion: There was no difference in outcome of uncomplicated CAP in previously healthy children less than 36 months of age between those treated and not treated with antibiotics. Additional tools are needed to facilitate identification of viral CAP in young children and decrease unnecessary antibiotic use.