Antibiotic Use for Children with Pneumonia: Sustained Adoption of National Guidelines at United States Children's Hospitals
Bibliographic record
Abstract
Background. Consensus national guidelines (2011) recommend narrow-spectrum penicillins (penicillin, ampicillin, amoxicillin) for children hospitalized with uncomplicated pneumonia. Prior to guideline release, most hospitalized children received second/third generation cephalosporins. We assessed the impact of the national guideline and subsequent hospital-level interventions on antibiotic choice across a national sample. Methods. We identified children 6 months to 18 years from 28 children's hospitals admitted between August 2009 and March 2015 with a diagnosis of pneumonia and who received antibiotics within the first 2 hospital days. Each hospital was surveyed regarding local activities implemented after guideline release (e.g. clinical practice guideline [CPG]). Outcomes included the monthly percentage of children receiving penicillins or cephalosporins. Interrupted time series analysis was used to assess the national guideline impact by comparing the absolute change in prescribing at the end of the study ([observed % from post-guideline trend] – [expected % from pre-guideline trend]) aggregated across all hospitals. Hospital-level analyses assessed the impact of local activities. Results. A total of 58,559 pneumonia hospitalizations were included. Prior to the national guideline, penicillin use was rare (<10%); cephalosporins accounted for ∼60% of prescribing. After guideline release, 19 hospitals (68%) implemented a new CPG and 20 (71%) implemented a new order set. By the end of the study and compared with pre-guideline trends, we noted an absolute increase in penicillin use of 27.6% (95% CI: 23.7%–31.5%) [Figure 1]. Cephalosporin use declined by a similar magnitude (not shown). Prescribing changes varied across hospitals [Figure 2]. Among hospitals implementing a CPG or order set, the median difference was 29.5 [IQR 19.6, 39.1] for penicillins, while among hospitals without local activities, the median difference was 20.1 [9.5, 44.5]; these differences were not statistically significant. Conclusion. Antibiotic prescribing for pneumonia changed substantially after release of a national guideline, although institutional adoption varied. Local implementation efforts may enhance appropriate antibiotic selection, but room for improvement remains. Disclosures. A. L. Hersh, Merck: Grant Investigator, Research grant; C. G. Grijalva, Thrasher Research Fund: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant, Consultant, Consulting fee
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".