Pneumonia is one of the leading infectious causes of hospitalization and mortality in children worldwide. Community-acquired pneumonia (CAP) has multiple etiologies, with Streptococcus pneumoniae being the most common pathogen. Treatment is generally empirical, based on clinical and epidemiological criteria, due to the difficulty of isolating this agent. The adoption of clinical protocols is essential to guide management, favor positive outcomes and promote rational use of antimicrobials. To evaluate antimicrobial use in pediatric CAP, measuring adherence to the institutional protocol and clinical outcomes of cure, readmission and death. Retrospective cohort, quantitative study including patients who received antibiotics for CAP between June and December 2024 in a pediatric hospital (CAAE: 85964224.1.0000.5580). Cases without evidence of bacterial pneumonia or with comorbidities (e.g., asthma, cystic fibrosis, immunosuppression) were excluded. The analysis was based on clinical, laboratory and imaging data. Of 1,139 medical records reviewed, 287 patients (25%) were included, half of them aged up to 2 years. Use of antimicrobials according to the institutional protocol occurred in 74% of cases. The number of therapeutic regimens per patient ranged from 1 to 6. Complicated pneumonias accounted for 31% (n = 86) of cases; viruses were detected in 15%. The isolation rate of S. pneumoniae was 3.8% (n = 11), with penicillin susceptibility of 73% (S = 5, I = 3, R = 3) and ceftriaxone susceptibility of 100% (S = 11). In 31.7% (n = 91) of CAP cases, empirical treatment was initiated with penicillins; of these, 21 (23%) required escalation and 70 (77%) remained on penicillins. Cephalosporins were the first choice in 65% (n = 187) of cases (77% as monotherapy), with 10% requiring escalation, all in complicated CAP. Among all patients (n = 287), there was 98% cure, 0.3% mortality and 1.7% readmission within 30 days; 17% required ICU care. There was significant adherence to antimicrobial use according to the institutional protocol. Empirical penicillin use in pediatrics is a feasible strategy in one-third of patients, according to local and national pneumococcal epidemiology, especially in non-complicated CAP. Escalations generally occurred in complicated pneumonias and, despite the complexity of these cases, clinical outcomes were very favorable.
Sestren et al. (Sun,) studied this question.