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
- Established a system-wide board goal to switch to a common
antibiotic (ampicillin/amoxicillin) and reduce the number of
- 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.