Evaluation of the Treatment of Aspiration Pneumonia in Hospitalized Children.

BACKGROUND: Aspiration pneumonia (AP) treatment is variable with limited available guidance on optimal antibiotic choice and duration. This study evaluated the impact of antibiotic regimen and duration on treatment failure for AP in children and correlated the effects of antimicrobial stewardship program (ASP) interventions on treatment duration. METHODS: Hospitalized children who received antibiotics for AP were identified through an existing ASP repository. Diagnosis was confirmed through ASP documentation with either an international classification of diseases 9/10 code or physician diagnosis of AP. Incidence of treatment failure (necrotizing pneumonia, lung abscess, empyema, or retreatment) was compared between patients receiving shorter (≤7 days) vs longer (>7 days) course of antibiotics and between various empiric/final antibiotic regimens utilized. Duration of treatment was evaluated in patients with or without an ASP intervention. RESULTS: Four hundred and nineteen treatment courses for AP were included. Nineteen episodes (4.5%) of treatment failure were identified. No difference in treatment failure was observed between shorter vs longer courses (8 vs 11 episodes). An aminopenicillin plus beta-lactamase inhibitor was most frequently utilized for both empiric (47.2%) and final treatment (67.5%). Treatment failure rates did not differ with length of intravenous therapy nor empiric/final antibiotic regimen chosen. ASP interventions targeting duration were associated with significantly shorter courses (6.28 vs 7.46 days; P = .04). CONCLUSIONS: Shorter courses of antibiotics did not result in more treatment failure for AP when compared to longer courses. Neither antibiotic choice nor route impacted treatment failure rates. ASPs may optimize the treatment of pediatric AP.

Characterization of Severe Adverse Drug Reactions at a Free-Standing Children's Hospital.

We performed a retrospective chart review on severe adverse drug reactions (ADRs) detected by a pharmacovigilance program at a free-standing pediatric hospital from January 2011 through September 2014. The pharmacist-led program identifies ADRs using electronic medical record triggers. A systematic approach was used to classify ADR type and severity and assure accurate documentation. Data collection included demographics, implicated medication, type of ADR, Naranjo probability scale, ADR-associated International Classification of Diseases, 9th Revision E codes, 30-day mortality, and health care visit cost. One hundred sixty-six severe pediatric ADRs were included, occurring in 163 unique patients. Severe ADRs were commonly associated with antimicrobials (48%), antineoplastics (10%), and antiepileptics (10%). The majority of ADRs were classified by the Naranjo probability scale as probable (59%). One hundred fifty-four patients were admitted to the hospital, with a median length of stay of 3 days; 22 of these patients required admission to the pediatric intensive care unit for a median of 3 days. The median estimated health care cost associated with severe ADRs was $4055.52. No deaths occurred. Nearly 40% of severe ADRs would have gone unidentified using ADR-associated International Classification of Diseases, 9th Revision E codes alone. The impact of pediatric ADRs on the health care system is underestimated. Strategies such as active pharmacovigilance programs enhance the identification, characterization, and documentation of these otherwise unrecognized ADRs.