Antibiotic choice for community-acquired pneumonia (CAP) in children varied across practices, and factors contributing to this variation include patient age, previous antibiotic receipt, and private insurance, according to a study published in Pediatrics.

Lori K Handy, MD, from the Division of Infectious Diseases, at the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware, and colleagues sought to determine the patient and clinician characteristics associated with the prescription of amoxicillin vs macrolide or other broad-spectrum antibiotics for CAP. The researchers conducted a retrospective cohort study in an outpatient pediatric primary care network from July 1, 2009 to June 30, 2013. Patients who were prescribed amoxicillin, macrolides, or a broad-spectrum antibiotic (amoxicillin-clavulanic acid, cephalosporin, or fluoroquinolone) for CAP were included.

A total of 10,414 children were included: 4,239 (40.7%) received amoxicillin, 4,430 (42.5%) received macrolides, and 1,745 (16.8%) received broad-spectrum antibiotics. The factors associated with an increased odds of receipt of macrolides compared with amoxicillin included patient age >5 years (odds ratio [OR], 6.18), previous antibiotic receipt (OR, 1.79), and private insurance (OR, 1.47). The predicted probability of a child being prescribed a macrolide ranged significantly between 0.22 and 0.83 across clinics. The nonclinical characteristics associated with an increased odds of receipt of broad-spectrum antibiotics compared with amoxicillin included suburban practice (OR, 7.50) and private insurance (OR, 1.42).

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“Antibiotic choice for CAP varied widely across practices,” said the authors. “Factors unlikely related to the microbiologic etiology of CAP were significant drivers of antibiotic choice. Understanding drivers of off-guideline prescribing can inform targeted antimicrobial stewardship initiatives.”


  1. Handy LK, Bryan M, Gerber JS, et al. Variability in Antibiotic Prescribing for Community-Acquired Pneumonia. Pediatrics. 2017 Mar 7. doi: 10.1542/peds.2016-2331