{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T13:27:45Z","timestamp":1794317265558,"version":"4.9.0"},"reference-count":30,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"\n \n <\/jats:sec>\n \n BACKGROUND<\/jats:title>\n There are no guideline recommendations for antibiotic choice for community-acquired pneumonia (CAP) in children with medical complexity (CMC). We compared broad- vs narrow-spectrum antibiotics in CMC hospitalized with nonsevere CAP.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This cohort study was conducted using target trial emulation within an academic health system. We included hospitalizations from January 2016 to April 2024 with International Classification of Diseases, 10th Revision (ICD-10) codes for CAP and complex chronic conditions among children aged 3\u00a0months to 21\u00a0years who received 3 or more days of antibiotics. We excluded children with severe\/complicated CAP, chronic pulmonary conditions, sickle cell disease, tracheostomies, immunosuppression, other bacterial infections, or recent CAP admission. The exposure was initial broad-spectrum antibiotics (CAP antibiotics other than aminopenicillins) within 12 hours of presentation. The primary outcome was time to discharge, censored at day 10. Secondary outcomes were progression to severe CAP and 30-day CAP-related revisits. To mitigate confounding, we applied inverse probability of treatment weighting in outcome models, including a Royston-Parmar flexible survival model for time to discharge, and logistic regression for binary outcomes.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n A total of 847 encounters (749 patients) were included. After weighting and trimming, 742 encounters remained with adequate covariate balance. Compared with the narrow-spectrum group, the broad-spectrum group demonstrated no significant differences in time to discharge (hazard ratio, 0.84; 95% CI, 0.68\u20131.04), progression to severe CAP (odds ratio [OR], 1.29; 95% CI, 0.7\u20132.4), or 30-day CAP-related revisits (OR, 0.39; 95% CI, 0.1\u20131.2).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n In CMC hospitalized with nonsevere CAP, initial broad-spectrum antibiotics did not improve clinical outcomes compared with narrow-spectrum antibiotics, supporting the use of aminopenicillins for nonsevere CAP in many CMC.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.2026-076178","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:02:06Z","timestamp":1791331326000},"source":"Crossref","is-referenced-by-count":0,"title":["Antibiotic Choice for Community-Acquired Pneumonia in Children With Medical Complexity"],"prefix":"10.1542","volume":"158","author":[{"given":"Maheswari","family":"Ekambaram","sequence":"first","affiliation":[{"name":"1Division of Infectious Diseases, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"},{"name":"2Current affiliation: Division of Infectious Diseases, Dell Children\u2019s Medical Center, Austin, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Li","sequence":"additional","affiliation":[{"name":"3Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania"},{"name":"4Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Thomson","sequence":"additional","affiliation":[{"name":"5Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children\u2019s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey S.","family":"Gerber","sequence":"additional","affiliation":[{"name":"1Division of Infectious Diseases, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"},{"name":"3Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania"},{"name":"4Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Chiotos","sequence":"additional","affiliation":[{"name":"1Division of Infectious Diseases, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"},{"name":"4Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania"},{"name":"6Department of Anesthesiology and Critical Care Medicine, Children\u2019s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"issue":"3","key":"2026111007573976100_r1","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1001\/jamapediatrics.2021.5171","article-title":"Common diagnoses and costs in pediatric hospitalization in the US","volume":"176","author":"Kaiser","year":"2022","journal-title":"JAMA Pediatr."},{"issue":"9","key":"2026111007573976100_r2","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1056\/NEJMoa1405870","article-title":"Community-acquired pneumonia requiring hospitalization among U.S. children","volume":"372","author":"Jain","year":"2015","journal-title":"N Engl J Med."},{"issue":"12","key":"2026111007573976100_r3","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1086\/673982","article-title":"Identifying targets for antimicrobial stewardship in children\u2019s hospitals","volume":"34","author":"Gerber","year":"2013","journal-title":"Infect Control Hosp Epidemiol."},{"issue":"7","key":"2026111007573976100_r4","doi-asserted-by":"crossref","first-page":"e25","DOI":"10.1093\/cid\/cir531","article-title":"The management of community-acquired pneumonia in infants and children older than 3\u00a0months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America","volume":"53","author":"Bradley","year":"2011","journal-title":"Clin Infect Dis."},{"issue":"6","key":"2026111007573976100_r5","doi-asserted-by":"crossref","first-page":"e20163021","DOI":"10.1542\/peds.2016-3021","article-title":". 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