Nearly one in five children diagnosed with pneumonia in outpatient settings did not receive antibiotics, according to a recent cohort study.

Researchers evaluated outpatient antibiotic use in pediatric pneumonia and associated treatment outcomes. Researchers examined a cohort of 103,854 Medicaid-insured children under 18 diagnosed with pneumonia between 2017 and 2019, focusing on treatment failure and severe outcomes across groups who did and did not receive antibiotics. Of the children analyzed, 20% did not receive antibiotics within 24 hours of diagnosis. Treatment failure occurred in 10.7% of children without antibiotics and 8.7% of those with antibiotics, yielding a risk difference of 1.98% (95% confidence interval [CI], 1.41-2.56). Severe outcomes, defined as hospitalization or complicated pneumonia, were infrequent, affecting 1.1% of the non-antibiotic group and 0.7% of those receiving antibiotics, with a risk difference of 0.46% (95% CI, 0.28-0.64).

The study also revealed demographic differences in antibiotic use. Non-Hispanic Black children and those discharged from emergency departments had lower antibiotic prescription rates compared to non-Hispanic White children and those seen in urgent care or outpatient clinics. Children aged 1 to 4 years and those with complex chronic conditions also demonstrated variations in antibiotic receipt.

These findings, published in JAMA Network Open, indicate that, while outpatient antibiotic treatment for pediatric pneumonia is associated with a modest reduction in treatment failure, severe outcomes remain rare across groups. The results highlight those certain pediatric cases of mild pneumonia experienced low rates of severe outcomes without antibiotic treatment, suggesting further research is needed to clarify which children may be managed effectively without immediate antibiotics.

Full disclosures can be found in the original study.