Rightsizing Treatment for Pneumonia in Children

Abstract

Antibiotics are the double-edged swords we love to wield. They save lives, but they also cause harm with adverse drug events and the promotion of antibiotic resistance. Antibiotic stewardship is the effort to optimize the use of antibiotics to the right antibiotic at the right time and for the right duration. Stewardship encourages us to ask ourselves: can we decrease the biological costs of using these powerful tools, even a little, if we put them away earlier? Evidence has accumulated that we can give shorter courses of antibiotics, at least to adult patients, for many conditions, including for pneumonia, urinary tract infections, sinusitis, and cellulitis.¹ This is welcome news to anyone who has taken antibiotics themselves or given their child an antibiotic and experienced diarrhea or a yeast infection; adverse events and effects are common, especially in children.² However, in children, evidence regarding the efficacy of shorter antibiotic courses is lacking for most common conditions. At least in part because of this uncertainty, most antibiotic courses prescribed to children in the US for common infections, including pneumonia, are 10 days in duration.³ This may be owing in part to the lack of strong evidence to guide recommendations for duration of therapy for many infections.