Vanderbilt Study Shows Penicillin Equally Effective As 'Big Gun' Antibiotics For Treating Less Severe Childhood Pneumonia

Children hospitalized for pneumonia have similar outcomes, including length of stay and costs, regardless of whether they are treated with "big gun" antibiotics such as ceftriaxone or cefotaxime or more narrowly focused antibiotics such as ampicillin or penicillin, according to a Vanderbilt study published in Pediatrics.

Study authors said the findings are important because pneumonia is one of the most common reasons for hospitalization among U.S. children and because broad-spectrum antibiotics are frequently overprescribed, leading to antibiotic resistance.

"Sometimes there is a perception, not restricted to pneumonia, that the use of a broad spectrum antibiotic, a big gun, is going to be the best treatment for all patients. This perception can complicate the selection of antibiotics especially when there is limited information to support the decision," said senior author Carlos G. Grijalva, M.D., assistant professor of health policy. "To help inform those decisions, this study compared two pneumonia treatment regimens, a big gun [broad spectrum antibiotics] vs. a small gun [narrow spectrum antibiotics], and found there were no significant differences in clinical outcomes or associated costs."

In 2011, the Pediatric Infectious Diseases Society and Infectious Diseases Society of America released joint community-acquired pneumonia guidelines that recommend narrow-spectrum antibiotic therapy for most children hospitalized with pneumonia; however, until now, few studies had compared the effectiveness of this strategy relative with use of broad spectrum antibiotics.

Using data from 43 children's hospitals in the United States, the authors compared outcomes among children 6 months to 18 years of age hospitalized for pneumonia between 2005 and 2011, receiving either ampicillin or penicillin [narrow spectrum] or a third generation cephalosporin [ceftriaxone or cefotaxime — broad spectrum]. According to the PIDS/IDSA guidelines, both treatment strategies are effective for disease caused by Streptococcus pneumoniae, the most common bacterial cause of pneumonia. 

Lead author Derek J. Williams, M.D. MPH, assistant professor of pediatrics, said doctors worry about increases in unnecessary use of broad spectrum antibiotics because they drive increases in disease caused by antibiotic-resistant bacteria. "We have seen increases in use of broad spectrum antibiotics and concurrent increases in disease caused by resistant bacteria.

For this study, we hypothesized that narrow and broad-spectrum antibiotics would have similar effectiveness in the treatment of childhood pneumonia. Our findings support the preferential use of narrow spectrum antibiotics as first-line therapies for most children hospitalized with pneumonia."