Antibiotics for hospitalized children with community-acquired pneumonia in Japan: Analysis based on Japanese national database

Introduction: Community-acquired pneumonia (CAP) is one of the most common causes of pediatric infection requiring hospitalization. Antimicrobial resistance due to the inappropriate use poses a threat worldwide. Our objective is to analyze and optimize the trends of antibiotics used for pediatric inpatients with CAP in a claims database provided by the Ministry of Health, Labour and Welfare. Methods: Our database randomly sampled 10% of the hospitalized patients every October from 2011 to 2014. Patients aged <15 years in whom antibiotic therapy was initiated within two days of admission were listed. Subsequently, we investigated the antibiotics administered on the first day of prescription. Results: A total of 4,831 antibiotics were prescribed for 3,909 patients. Many patients aged <= five years were treated with beta-lactams alone whereas many patients aged >= six years were treated with a single antibiotic, such as a macrolide, tetracycline, and quinolone, which covers atypical bacteria. Combination therapy was primarily used in children aged >= six years (nearly 30%); the main combination was a beta-lactam and non-beta-lactam covering atypical bacteria. Ampicillin-sulbactam was the most frequently prescribed beta-lactam in children of all ages other than infants. Ampicillin, however, was most often prescribed in infants, but its usage rate was low at other ages. Conclusions: Antibiotics were appropriately prescribed and were similar to that recommended in the 2011 guidelines for pediatric inpatients with CAP. However, combination therapy was frequently prescribed in children aged >= six years. According to the revised guidelines in 2017, ampicillin should be used more frequently for patients hospitalized with CAP. (C) 2020 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.