Research In Practice Blog

Antibiotics
The Challenge of Doing Less: On Not Using Antibiotics to Treat Mild Pneumonia in Young Children
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By Julia E. Szymczak, PhD

Intro
Most young children with pneumonia who are well enough to be cared for at home have an infection caused by a virus, which does not need to be treated with antibiotics. Despite this, most children with mild pneumonia who are cared for in the outpatient setting receive an antibiotic. To improve how antibiotics are used for children with pneumonia it is important to understand the reasons why it might be difficult to not use them. A research team set out to identify these reasons.

Study design & findings
The qualitative study used semi-structured interviews with 38 respondents (18 parents of children who had recently been diagnosed with pneumonia and 20 pediatric clinicians). Although both parents and clinicians expressed broad support for the judicious use of antibiotics, the study revealed obstacles to putting that into practice. Diagnostic uncertainty, fear of respiratory symptoms in young children, contextual factors surrounding the clinical encounter, and consequences of undertreating a bacterial infection were cited as hurdles to limiting the use of antibiotics for mild community-acquired pneumonia in young children. For parents, disagreeing with the assessment of “mild” pneumonia, meaning they perceive their child to be more ill than the clinician does, also contributes to a willingness to accept the risks of antibiotics even if there is a low likelihood they are needed. Using antibiotics when they are not needed can expose children to adverse effects and potentially severe complications, and lead to antibiotic resistance. Parents interviewed for the study noted they could be receptive to not receiving antibiotics for their child if there is trust in the clinician, communication of a clear rationale for the approach, and description of a contingency plan.

Research in Practice Implications 
This study strengthens the evidence base supporting the challenges of de-implementation in antibiotic stewardship and the need to pay attention to the social, emotional and cultural meanings of pneumonia for families and pediatricians.

Actionable Insights: 

  • Clinical: Engage families in clear communication for antibiotic decisions along with a contingency plan. 
  • Research: Research is needed on strategies to reduce antibiotic use for pneumonia that simultaneously empower families, like safety net antibiotic prescribing.
  • Advocacy/Policy: Focus on public communication and education about the harms of unnecessary antibiotics and the fact that recommendations about when to use antibiotics are changing as research advances.

Information & Resources
•    Read the full article here.
•    Antimicrobial Stewardship at CHOP
•    Antimicrobial Stewardship Research at Clinical Futures

Clinical Futures author(s): 
Julia E Szymczak, PhD and Jeffrey S Gerber, MD, PhD

Citation: 
Julia E. Szymczak, Ashley A. Hayes, Patricia Labellarte, Julian Zighelboim, Amandeep Toor, Adam B. Becker, Jeffrey S. Gerber, Nathan Kuppermann, Todd A. Florin; Parent and Clinician Views on Not Using Antibiotics for Mild Community-Acquired Pneumonia. Pediatrics February 2024; 153 (2): e2023063782. 10.1542/peds.2023-063782