Pneumonia is the leading cause of death in children worldwide. Each year, more than 2 million children younger than 5 years old die from pneumonia, representing approximately 20 percent of all deaths in children within this age group. Within Intermountain, pneumonia is the fourth-most common reason for a pediatric admission to the hospital and is the pediatric condition with the fourth-highest cost.

When the Pediatric Infectious Disease Society and Infectious Disease Society of America published a new national guideline for the management of community acquired pneumonia (CAP) in 2011, Intermountain’s Pediatric Specialties Clinical Program evaluated their practices to continue providing pediatric patients with the best possible evidence-based care and launched a care process model that incorporated the national recommendations.

The Pediatric Clinical Program tackles the misuse of antibiotics

The team also evaluated the practice within our system to gauge consistency with national guidelines in treating children with community-acquired pneumonia (CAP). They found that most children with CAP were receiving antibiotics, and more than 30 widespectrum antibiotics were being prescribed. The national guideline directed the use of penicillins that are narrow-spectrum and very effective for agents that cause CAP. Penicillins were often not being prescribed at Intermountain. These practices, before evaluation, meant Intermountain caregivers were exposing kids to antibiotics unnecessarily and increasing their risk to develop antibiotic resistance.

The Pediatric Clinical Program, with system-wide support of many teams, worked to address the issue through the following tactics:

  • Developed tools such as the CAP care process model and a flashcard to help educate and guide pediatric clinicians to follow best practices for antibiotic use, testing, and other protocols.
  • Established a system-wide board goal to switch to a common antibiotic (ampicillin/amoxicillin) and reduce the number of wide-spectrum antibiotics.
  • Implemented training, led by our infection control team, to educate pediatric teams about the new guidelines, process, and goals. This effort included education at grand rounds, presentations to pediatric teams, and distribution of the tools.
  • Created partnerships with Primary Children’s antibiotic stewardship program (which includes infectious disease and pharmacy) to help monitor antibiotic usage.
  • Educated the public about appropriate use of antibiotics.

Children benefit from effective antibiotic use

Within a few months, Intermountain achieved 90 percent compliance system-wide with our goal to use ampicillin/amoxicillin for care of CAP. In addition, investigations have found that clinicians aren’t prescribing antibiotics for children when they aren’t effective, such as with viral pneumonia. These results are leading to children’s long-term protection.