Narrow as good as broad spectrum antibiotics in uncomplicated pneumonia

by Sonny Tat 
Children's National

Stephen Teach sent an article about the comparative effectiveness of narrow-spectrum antibiotics for uncomplicated pneumonia. Published this December in Pediatrics, the study used retrospective data to compare outcomes of patients 2 months to 18 years old at 4 sites with the discharge diagnosis of pneumonia. There were a total of 492 patients in the study.

Despite published recommendations recommending narrow-spectrum antibiotic use, this study found that the rate of narrow-spectrum use ranged from 18% to 88% in the 4 hospitals. There was no difference between the narrow and broad spectrum groups in duration of oxygen, rate of readmission, and duration of fever. The LOS was shorter and the cost was lower in the narrow spectrum group. This article reaffirms the recommendations that we should stick with narrow-spectrum antibiotics in treating uncomplicated pneumonia.

This was a comparative effectiveness study, which is a different from a traditional outcomes study. The differences seem subtle at first but the distinction is important as we begin to accept the reality that health care must be evaluated with real world conditions in mind. Comparative effectiveness uses evidence from original research and systematic reviews to make head to head comparisons in useful study populations with a goal of helping us decide between available alternatives. Whereas traditional research may use placebos as comparisons, comparative effectiveness research usually compares to established standards. Comparative effectiveness puts costs into the equation, helping us answer the hard questions of whether we should use an intervention if it is both more effective and more expensive or less effective and also less expensive. 

Comparative effectiveness helps us answer "by how much?"