Why do children hospitalised with pneumonia not receive antibiotics in primary care?
- 1Department of Paediatrics, University of Auckland and Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
- 2Department of Primary Health Care, University of Oxford, Oxford, England
- 3General Paediatrics, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
- 4General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand
- Correspondence to Cameron Grant, Department of Paediatrics, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand; cc.grant{at}auckland.ac.nz
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Contributors CCG obtained funding and ethical approval for the project. CCG, AH and DM designed the study, participated in the data analysis and completed the first draft of the manuscript. CCG and DE led the project through the collection and management of the data and the data analysis. DE and GC edited the draft manuscript.
- Received 1 July 2011
- Accepted 25 October 2011
- Published Online First 18 November 2011
Abstract
Background Although antibiotics are recommended for the primary care management of community-acquired pneumonia, a recent UK study reported that most children admitted to hospital had not received antibiotics.
Objective To describe primary care antibiotic use for children subsequently hospitalised with community-acquired pneumonia.
Design/methods A case series of 280 children <5 years old hospitalised with pneumonia in Auckland, New Zealand. Pneumonia was defined as an acute illness with cough or respiratory distress, the presence of tachypnoea or indrawing and an abnormal chest radiograph. Receipt of antibiotics was determined by parental report and medical record review.
Results Fewer than half (108, 39%) of the children had received an antibiotic before hospital admission. For 60 children (21%) there had been no opportunity to prescribe because the illness evolved rapidly, resulting in early hospital admission. For the remaining 112 children (40%) an opportunity to receive antibiotics was missed. The parent failed to obtain the antibiotic prescribed for 23 children (21% of 112), but in 24 children (21%) pneumonia was diagnosed but no antibiotic prescribed and in a further 28 children (25%) the diagnosis was not made despite parental report of symptoms suggesting pneumonia. Missed opportunities to prescribe were not associated with increased overall severity of symptoms at hospital presentation but were associated with an increased risk of: focal chest radiological abnormalities (rate ratio (RR)=2.14; 95% CI 1.49 to 2.83), peripheral leucocytosis >15×109/l (RR=2.29; 95% CI 1.61 to 2.98) and bacteraemia (RR=6.68, 95% CI 1.08 to 58.44).
Conclusions Young children with community-acquired pneumonia may not receive an antibiotic before hospital admission because the illness evolves rapidly or the prescribed medicine is not given by parents. However, missed opportunities for appropriate antibiotic prescribing by health professionals in primary care appear to be common.
Footnotes
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Funding This project was funded by research grants from the Health Research Council of New Zealand, the Auckland Medical Research Foundation and the National Child Health Research Foundation. CCG was supported by an overseas fellowship with the National Institute of Health Research National School of Primary Care.
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Competing interests None.
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Ethics approval The Ministry of Health Northern Regional Ethics Committee approved the study.
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Provenance and peer review Not commissioned; externally peer reviewed.
