A lack of practical tools makes it difficult for health care providers to differentiate between the bacterial and viral causes of community-acquired pneumonia in children. Thus, although the condition is most often due to a virus, antibiotics are frequently prescribed when the condition is suspected in children. A prospective cohort study was designed to determine the association between antibiotic prescriptions and treatment failure in children with suspected community-acquired pneumonia who were discharged from the ED, as well as the link between these prescriptions and parent-reported quality-of-life measures.

Children eligible for the study were three months to 18 years old and had symptoms of lower respiratory tract infection and a chest radiograph owing to clinical suspicion of pneumonia. Those who had been hospitalized in the previous 14 days, had a chronic complex condition, or were taking antibiotics at the time of enrollment were excluded. Of the 337 children (mean age, 3.4 years) included in the study, approximately 50% received antibiotics.

After matching by propensity scores, 294 children remained in the final analysis. Of these children, 26 experienced treatment failure; among these, there was no statistical difference between those who did and didn't receive antibiotics. Similarly, the researchers found no statistical difference between the groups regarding return visits with hospital admission, return visits with a change in antibiotics, or the initiation of or a change in antibiotics within two weeks of discharge. There were also no statistically significant differences between the groups in parent-reported quality-of-life measures.

Noting the limitations of this study, the researchers point out that most patients with radiographic pneumonia were in the group that received antibiotics, which may have affected the results. Also, the type of antibiotic was not a factor in their analysis, the sample size was limited, and almost a quarter of patients were lost to phone follow-up.