Adjunct Systemic Corticosteroid Therapy in Children With Community-Acquired Pneumonia in the Outpatient Setting.

Abstract

BACKGROUND:

The role of adjunct systemic corticosteroid therapy in children with community-acquired pneumonia (CAP) is not known. The objective was to determine the association between adjunct systemic corticosteroid therapy and treatment failure in children who received antibiotics for treatment of CAP in the outpatient setting.

METHODS:

The study included a retrospective cohort study of children, aged 1-18 years, with a diagnosis of CAP who were managed at an outpatient practice affiliated with Geisinger Health System from January 1, 2008 to January 31, 2010. The primary exposure was the receipt of adjunct corticosteroid therapy. The primary outcome was treatment failure defined as a respiratory-associated follow-up within 14 days of diagnosis in which the participant received a change in antibiotic therapy. The probability of receiving adjunct systemic corticosteroid therapy was calculated using a matched propensity score. A multivariable conditional logistic regression model was used to estimate the association between adjunct corticosteroids and treatment failure.

RESULTS:

Of 2244 children with CAP, 293 (13%) received adjunct corticosteroids, 517 (23%) had underlying asthma, and 624 (28%) presented with wheezing. Most patients received macrolide monotherapy for their CAP diagnosis (n = 1329; 59%). Overall, treatment failure was not associated with adjunct corticosteroid treatment (odds ratio [OR], 1.72; 95% confidence interval [CI], 0.93 and 3.19), but the association was statistically significant among patients with no history of asthma (OR, 2.38; 95% CI, 1.03 and 5.52), with no statistical association among patients with a history of asthma.

CONCLUSION:

Adjunct corticosteroid therapy was associated with treatment failure among children diagnosed with CAP who did not have underlying asthma.

• Authors: Lilliam Ambroggio, Matthew Test, Joshua P Metlay, Thomas R Graf, Mary Ann Blosky, Maurizio Macaluso, Samir S Shah
• Journal: Journal of the Pediatric Infectious Diseases Society (J Pediatric Infect Dis Soc) Vol. 4 Issue 1 Pg. 21-7 (Mar 2015) ISSN: 2048-7207 [Electronic] England
• PMID: 26407353 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © The Author 2014. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: [email protected].

Chemical References

• Adrenal Cortex Hormones
• Anti-Bacterial Agents
• Dexamethasone
• Prednisolone
• Prednisone

Topics

• Adolescent
• Adrenal Cortex Hormones (therapeutic use)
• Anti-Bacterial Agents (therapeutic use)
• Asthma (complications, drug therapy, epidemiology)
• Child
• Child, Preschool
• Dexamethasone (therapeutic use)
• Drug Therapy, Combination
• Follow-Up Studies
• Humans
• Infant
• Logistic Models
• Multivariate Analysis
• Outpatients (statistics & numerical data)
• Pneumonia (complications, drug therapy, epidemiology)
• Prednisolone (therapeutic use)
• Prednisone (therapeutic use)
• Respiratory Sounds (drug effects)
• Retrospective Studies
• Treatment Failure