University of Ottawa and Children’s Hospital of Eastern Ontario, Canada
Jennifer Bowes is currently working in University of Ottawa at Canada
Background:Increasing penicillin resistance to Streptococcus pneumoniaein the late 1990’sled to increased use of ceftriaxone and cefuroxime for children with community acquired pneumonia (CAP). In 2007-8 only 2% of patients with CAP at CHEO were prescribed ampicillin. In January 2008, the Clinical and Laboratory Standards Institute published revised penicillinsusceptibility breakpoints for treatment of non-meningeal infections due to S. pneumoniae. Methods:ICD-10 discharge codes for pneumonia were used to identify previously healthy patients with a diagnosis of CAP between January1, 2012 and December 31, 2013. Radiograph reportswere reviewed to determine the presence of lobar infiltrates. Chart reviews identified patient characteristics, presence of complicated pneumonia and antimicrobial therapy. Results:235 children, 110 (46.8%) females, were admitted for CAP of which 212 (90%) had received routine immunizations and 21 (8.9%) reported allergies to penicillin. Overall, 208 (88.5%) reported cough, 204 (86.8%) fever, and 119 (50.9%) shortness of breath. In total, 173 (73.6%) had blood cultures; 7 were positive (5 S.pneumoniae, 2 Alpha-hemolytic Streptococcus). Thirty (12.8%) had drainage of empyema fluid (2 grew alpha-hemolytic streptococcus and 1 Streptococcus pyogenes). During the hospitalization, 149 (63.4%) received ampicillin and 81(34.5%) received cefuroxime. At discharge, 215 (91.5%) were given antimicrobials of which 164 (76.3%) received amoxicillin. Conclusions: Empiric therapy of CAP is necessary since precise etiology is not available at the bedside. The act of lowering the MIC for non-meningeal infections due to S. pneumoniaewas instrumental for clinicians to regain confidence in the use of penicillins as treatment for pneumonia.