{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T03:02:23Z","timestamp":1791428543156,"version":"4.3.3"},"reference-count":29,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,4,1]]},"abstract":"<jats:sec><jats:title>BACKGROUND AND OBJECTIVES:<\/jats:title><jats:p>Published guidelines recommend amoxicillin for most children with community-acquired pneumonia (CAP), yet macrolides and broad-spectrum antibiotics are more commonly prescribed. We aimed to determine the patient and clinician characteristics associated with the prescription of amoxicillin versus macrolide or broad-spectrum antibiotics for CAP.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>Retrospective cohort study in an outpatient pediatric primary care network from July 1, 2009 to June 30, 2013. Patients prescribed amoxicillin, macrolides, or a broad-spectrum antibiotic (amoxicillin\u2013clavulanic acid, cephalosporin, or fluoroquinolone) for CAP were included. Multivariable logistic regression models were implemented to identify predictors of antibiotic choice for CAP based on patient- and clinician-level characteristics, controlling for practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>Of 10\u2009414 children, 4239 (40.7%) received amoxicillin, 4430 (42.5%) received macrolides and 1745 (16.8%) received broad-spectrum antibiotics. The factors associated with an increased odds of receipt of macrolides compared with amoxicillin included patient age \u22655 years (adjusted odds ratio [aOR]: 6.18; 95% confidence interval [CI]: 5.53\u20136.91), previous antibiotic receipt (aOR: 1.79; 95% CI: 1.56\u20132.04), and private insurance (aOR: 1.47; 95% CI: 1.28\u20131.70). The predicted probability of a child being prescribed a macrolide ranged significantly between 0.22 and 0.83 across clinics. The nonclinical characteristics associated with an increased odds of receipt of broad-spectrum antibiotics compared with amoxicillin included suburban practice (aOR: 7.50; 95% CI: 4.16\u201313.55) and private insurance (aOR: 1.42; 95% CI: 1.18\u20131.71).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>Antibiotic choice for CAP varied widely across practices. Factors unlikely related to the microbiologic etiology of CAP were significant drivers of antibiotic choice. Understanding drivers of off-guideline prescribing can inform targeted antimicrobial stewardship initiatives.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2016-2331","type":"journal-article","created":{"date-parts":[[2017,3,7]],"date-time":"2017-03-07T10:10:10Z","timestamp":1488881410000},"source":"Crossref","is-referenced-by-count":66,"title":["Variability in Antibiotic Prescribing for Community-Acquired Pneumonia"],"prefix":"10.1542","volume":"139","author":[{"given":"Lori K.","family":"Handy","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Nemours\/Alfred I. duPont Hospital for Children, Wilmington, Delaware;"},{"name":"Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Bryan","sequence":"additional","affiliation":[{"name":"Center for Pediatric Clinical Effectiveness and"},{"name":"Department of Biostatistics and Epidemiology,"},{"name":"Center for Clinical Epidemiology and Biostatistics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey S.","family":"Gerber","sequence":"additional","affiliation":[{"name":"Center for Pediatric Clinical Effectiveness and"},{"name":"Department of Biostatistics and Epidemiology,"},{"name":"Center for Clinical Epidemiology and Biostatistics, and"},{"name":"Division of Infectious Diseases, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania; and"},{"name":"Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theoklis","family":"Zaoutis","sequence":"additional","affiliation":[{"name":"Center for Pediatric Clinical Effectiveness and"},{"name":"Department of Biostatistics and Epidemiology,"},{"name":"Center for Clinical Epidemiology and Biostatistics, and"},{"name":"Division of Infectious Diseases, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania; and"},{"name":"Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen A.","family":"Feemster","sequence":"additional","affiliation":[{"name":"Center for Pediatric Clinical Effectiveness and"},{"name":"Division of Infectious Diseases, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania; and"},{"name":"Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2017,4,1]]},"reference":[{"issue":"3","key":"2021120916133610200_B1","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1542\/peds.2010-2008","article-title":"Ambulatory visit rates and antibiotic prescribing for children with pneumonia, 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