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Early and Appropriate Antibiotic Treatment Is Essential for Kids with Suspected Pneumonia

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In critically ill children with pneumonia, delays of even a few hours to treatment with the correct antibiotic can mean more days in the hospital, reports a study in the April issue of the Pediatric Infectious Disease Journal.

The results highlight the need for "early and appropriate" antibiotic treatment for critically ill in whom bacterial pneumonia is a possibility, according to the study by Dr. Jennifer A. Muszynski of Nationwide Children's Hospital, Columbus, Ohio.

The researchers analyzed 45 infants and children, median age 17 months, who developed severed pneumonia requiring mechanical ventilation between 2004 and 2006. (Children with viral pneumonia or hospital-acquired pneumonia were excluded.) For each child, the time to treatment with the "correct" antibiotic for the bacteria causing pneumonia was assessed.

When treating children with suspected bacterial pneumonia, doctors need to make a quick decision about antibiotic treatment. They choose an "empiric" antibiotic based on the likely cause of the infection. Meanwhile, tests are performed to confirm that the chosen antibiotic will actually kill the causative bacteria. If not, the patient is switched to the correct antibiotic as soon as the test results are in.

In the study, 71 percent of children with pneumonia were initially treated with the correct antibiotic. Including children whose antibiotic was changed after bacterial testing, the median (midpoint) time to treatment with the correct antibiotic was about 10 hours, with a range of 2 to 38 hours.

With adjustment for severity of illness, children with shorter times to correct antibiotic treatment spent fewer days in the hospital. One child died of pneumonia caused by antibiotic-resistant staph bacteria (methicillin-resistant Staphylococcus aureus, or MRSA).

About half of the children had pneumonia as their only medical problem. For this group, longer times to correct antibiotic treatment were associated not only with longer hospital stay, but more time in the ICU and more time on mechanical ventilation.

Delays as short as two to four hours were associated with a longer hospital stay. For example, a six-hour delay to treatment with the correct antibiotic was linked to one additional day on mechanical ventilation and two additional days in the hospital, with most of that time spent in the ICU.

The optimal timing of antibiotic treatment for children with severe pneumonia is unclear. Studies in adults suggest that the key issue is the time to treatment with an antibiotic effective in killing the bacterial cause of pneumonia.

"Ours is the first study of the associations between timing and selection of empiric antibiotics and outcomes in critically ill children with bacterial [pneumonia]," Muszynski and colleagues write. The results confirm the importance of prompt treatment with the correct antibiotic, showing increased length of hospital stay for children with even relatively short delays to effective treatment.

The researchers note that, for most children with prolonged times to correct antibiotic treatment, "this was not due to administration of an incorrect drug, but rather to a delay in administration of the first dose of antibiotic." They emphasize the importance of prompt, appropriate antibiotic treatment "in children with acute respiratory failure for whom an infectious [cause] is a possibility."

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