Antibiotic Prescription in Children Hospitalized for Community-acquired Pneumonia

Study Overview
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Brief Summary
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A study to observe how often antibiotics are prescribed in children hospitalized for pneumonia and how doctors decide if a child needs antibiotics or not. Parent satisfaction will also be recorded.

Detailed Description
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An observational study to document the antibiotic treatment rate of children hospitalized for community acquired pneumonia at a pediatric department with longstanding practice of restrictive antibiotic prescribing. Patients will be enrolled consecutively and treated according to in-house standard operating procedure. Antibiotic treatment rate, severity of disease and medical complication rate in antibiotic and non-antibiotic managed children, frequency of predefined factors in physician decision making on antibiotic use, and parental satisfaction will be recorded. Parents will be contacted at least 4 weeks after discharge to inquire about recurrence or readmission.

Official Title
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Antibiotic Prescription in Children Hospitalized for Community-acquired Pneumonia: a Prospective, Observational Study

Conditions
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Community Acquired Pneumonia in Children, Antibiotic Stewardship

Intervention / Treatment
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* Other: Antibiotic treatment
* Other: No antibiotic treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Hospital admission at the pediatric department of the Filderklinik or at the pediatric department of the Herdecke Community Hospital Admission diagnosis pneumonia or pneumonia diagnosis within 48 hours of admission Written informed consent by care giver All inclusion criteria have to be fulfilled Exclusion Criteria: Insufficient knowledge of German to understand the written patient information and questionnaire

Ages Eligible for Study
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Minimum Age: 3 Months
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Pneumonia with antibiotics<br>Children with non-severe community acquired pneumonia and fever: managed with antibiotics | Other: Antibiotic treatment<br>* Antibiotic treatment<br>|
| Pneumonia without antibiotics<br>Children with non-severe community acquired pneumonia and fever: managed without antibiotics | Other: No antibiotic treatment<br>* No antibiotic treatment<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Antibiotic treatment rates in hospitalized children with non-severe community-acquired pneumonia and fever | Rates of treatment with and without antibiotics during hospitalization | During hospitalization, an average of 7 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of medical complications | Medical complications defined as a) admission to intensive care, mechanical ventilation, transfer to tertiary car center OR b) pleural effusion or empyema, pneumothorax, lung abscess, bronchopleural fistula, necrotizing pneumonia, acute respiratory failure, infectious complication (meningitis, septic shock). | During hospitalization, an average of 7 days | 
| Factors in physician decision making on antibiotic prescription | Physician questionnaire (closed-ended questions) | During hospitalization, an average of 7 days | 
| Parental satisfaction | Parental satisfaction questionnaire (closed-ended questions) | At discharge, assessing the entire duration of the hospital stay, an average of 7 days | 
| Hospitalization duration | Number of hospitalization days | At discharge, assessing the entire duration of the hospital stay, an average of 7 days | 
| Number of children with relevant comorbidity | Co-morbidities that may affect decision on antimicrobial use: a) chronic conditions (e.g. neurological conditions such as cerebral palsy, Down syndrome; or chronic respiratory conditions such as asthma, cystic fibrosis; or heart conditions). b) acute infectious comorbidities: bronchiolitis, otitis media, urinary tract infection, confirmed influenza virus or Respiratory Syncytial Virus or SARS-CoV2. | During hospitalization, an average of 7 days | 
| Days of supplemental oxygen use | Oxygen therapy for O2 saturation <92% | During hospitalization, an average of 7 days | 
| Use of antipyretic medications | Number of doses of paracetamol or ibuprofen during hospitalization | During hospitalization, an average of 7 days | 
| Number of complementary medicine medications used per child | Number of complementary medication during hospitalization | During hospitalization, an average of 7 days | 
| Number of readmissions for pneumonia or new pneumonia recurrences within 4 weeks of hospital discharge | New hospital admission for pneumonia; treatment requiring recurrence of pneumonia | 4 weeks after end of hospitalization | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Community acquired pneumonia, Antibiotic use, Pediatrics, Hospitalised children, Integrative medicine