{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T18:08:29Z","timestamp":1773252509343,"version":"3.50.1"},"reference-count":28,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"\n BACKGROUND<\/jats:title>\n Despite national guidelines on appropriate antibiotic therapy, there is wide variation in antibiotic decision-making for children with community-acquired pneumonia. This study sought to determine prevalence and factors associated with guideline-concordant antibiotic use in children presenting with pneumonia to the emergency department (ED).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n We enrolled children aged younger than 18\u00a0years presenting to the ED at 2 US children\u2019s hospitals between September 2017 and May 2019 with clinical and radiographic pneumonia. The primary outcome was guideline-concordant antibiotic use as defined by the 2011 Infectious Diseases Society of America pediatric pneumonia guideline and local expert consensus. Outcomes included proportion of antibiotic use and proportion of guideline-concordant treatment. We used multivariable logistic regression models to determine associations of comorbidities and functional limitations, clinical findings, and radiographic characteristics with overall antibiotic use and guideline-concordant treatment.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Among 772 included children, 573 received antibiotics (74.2%), and 441 (57.1%) received guideline-concordant antibiotic treatment. Antibiotic initiation was less likely in those with interstitial findings on chest radiograph (adjusted odds ratio [aOR], 0.14; 95% CI, 0.07\u20130.25) and negative results or nonperformance of viral testing (aOR, 0.39; 95% CI, 0.24\u20130.65). Guideline-concordant treatment was more likely in those with chest indrawing (aOR, 2.22; 95% CI, 1.34\u20133.66) and less likely in those with clinically significant effusion (aOR, 0.21; 95% CI, 0.06\u20130.76).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Among children presenting to the ED with pneumonia, more than 40% received treatment inconsistent with guideline recommendations. These observations underscore opportunities to improve appropriate antibiotic use in this population.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/hpeds.2024-007994","type":"journal-article","created":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T00:03:49Z","timestamp":1741046629000},"page":"300-308","source":"Crossref","is-referenced-by-count":3,"title":["Guideline-Concordant Antibiotic Use in Children With Community-Acquired Pneumonia"],"prefix":"10.1542","volume":"15","author":[{"given":"James W.","family":"Antoon","sequence":"first","affiliation":[{"name":"1Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Nian","sequence":"additional","affiliation":[{"name":"2Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Todd","sequence":"additional","affiliation":[{"name":"3Meharry Medical College, Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krow","family":"Ampofo","sequence":"additional","affiliation":[{"name":"4Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuwei","family":"Zhu","sequence":"additional","affiliation":[{"name":"2Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Sartori","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee"},{"name":"5Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jakobi","family":"Johnson","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald H.","family":"Arnold","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justine","family":"Stassun","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew T.","family":"Pavia","sequence":"additional","affiliation":[{"name":"4Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos 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