Antibiotic treatment for paediatric outpatients with community-acquired pneumonia: findings from 10 years of prescribing habits in Italy

26 Apr, 2020

Authors: P. Costenaro, A. Cantarutti, E. Barbieri, A. Scamarcia, A. Oletto, P. Sacerdoti, R. Lundin, L. Cantarutti, C. Giaquinto, D. Dona’

Published in: 30th European Congress on Clinical Microbiology and Infectious Diseases (ECCMID), April 2020

Background: Despite national and international efforts to promote appropriate antibiotic prescribing, Italian paediatric antimicrobial prescription rates are among the highest in Europe, with an overuse of broad-spectrum antibiotics. Community-acquired pneumonia (CAP) is one of the most common infections in pediatrics, and a main cause of antibiotic prescriptions. Aim of this study is to describe the first-line treatment approach for CAP at primary care level in Italian children.

Materials/methods: Retrospective observational study conducted among children with CAP enrolled in Pedianet, a network of community-based paediatricians from 12 Italian regions ( Children (3 months-14 years of age) with at least one reported CAP from 01/01/2009 to 31/12/2018 were included, if treated with antibiotics (ABT). CAP was defined according to ICD-9-CM (codes 485, 486, 482.9, 481), a new episode was recorded if occurring >=30 days after previous CAP. We defined “narrow-spectrum” (NS) ABT if treatment was amoxicillin and “broad-spectrum” (BS) if amoxicillin/clavulanic acid, cephalosporins or any combination ABT. Chi-squared and Fisher’s test were used for categorical or continuous variables. Crude and adjusted logistic regression for the ODDS of receiving a NS-ABT were conducted (all episodes of CAP and per patient). A p-value <0,05 was considered statistically significant.

Results: Among 9691 CAP, 7260 episodes from 6409 children followed by 147 pediatricians were included. The 16.7% of CAP (95% C.I.15,9%-17,6%) received a narrow-spectrum ABT while 53.3% (95% C.I.52%-54,4%) received a broad-spectrum ABT and 30% (95% C.I. 28,9%-31,1%) a macrolide. Within 10 years, an increasing trend of NS-ABT prescription was observed (p<0.001, Chi-square test for linear trend). Factors independently associated with reduced ODDS of receiving a NS-ABT compared to BS- ABT including macrolides were being older than 5 years (OR 0.45, 95% C.I.0.39 – 0.52), living in Center/South of Italy (OR 0.13, 95% C.I.0.10 – 0.16) and being exposed to ABT 3 months before (OR 0.61, 95% C.I. 0.53 – 0.70). These findings were confirmed comparing NS-ABT versus BS-ABT excluding macrolides (n=5079) and when adjusted analysis was limited to index CAP.

Conclusions: Our findings provide an alarming overview of the Italian prescribing habits, reporting a very limited use of NS-ABT for children with CAP.