Clinical Pathway Revision Increases Amoxicillin Monotherapy and 5-Day Durations of Therapy for Pediatric Community-Acquired Pneumonia in the Emergency Department and Urgent Care: A Quality Improvement Initiative - 19/11/25
Abstract |
Study objective |
The American Academy of Pediatrics recommends 5-day amoxicillin monotherapy as first-line treatment for pediatric uncomplicated community-acquired pneumonia. We aimed to use local quality improvement interventions to increase first-line amoxicillin use, reduce azithromycin use, and increase 5-day therapy durations for uncomplicated community-acquired pneumonia.
Methods |
A quality improvement initiative took place at a pediatric hospital network, including 4 emergency departments (EDs) and 5 urgent care centers. Children discharged between July 2018 and July 2022 with a community-acquired pneumonia diagnosis and an antibiotic prescribed were included. A 2-part intervention was implemented: (1) an electronic health record order set that preselected 5-day antibiotic therapy (August 2020) and (2) a revised community-acquired pneumonia pathway newly integrated into the electronic health record (April 2021). Proportions of antibiotic encounters receiving amoxicillin, azithromycin, and antibiotic durations of 5 days or fewer were analyzed using statistical process control charts to identify special cause variation.
Results |
Order set implementation had no effect on pediatric community-acquired pneumonia prescribing. After pathway revision, amoxicillin prescribing increased from 60.6% to 70.9%, azithromycin prescribing decreased from 12.5% to 3.7%, and durations for 5 days or fewer increased from 2.0% to 66.1%.
Conclusion |
A revised, electronic health record-integrated community-acquired pneumonia pathway was associated with improving already high adherence to guideline-recommended antibiotic choice and reducing antibiotic durations for pediatric community-acquired pneumonia in ED and urgent care settings. Local quality improvement efforts, when adapted to institutional workflows and culture, can effectively implement clinical pathways to support evidence-based prescribing for uncomplicated community-acquired pneumonia across diverse health care settings.
Le texte complet de cet article est disponible en PDF.Keywords : Pneumonia, Antibiotic stewardship, Quality improvement, Clinical pathway, Pediatric
Plan
| Please see page 587 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Lise E. Nigrovic, MD, MPH. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: MJW contributed to study conceptualization and data collection, conducted the analyses, and drafted and revised the manuscript. CEM provided antimicrobial stewardship expertise, contributed to the intervention design, and critically reviewed the manuscript. LAB and JMC helped develop and revise the clinical pathway and critically reviewed the manuscript. LA revised the clinical pathway, provided methodological expertise in study design and statistical analysis, assisted in interpreting data, and critically revised the manuscript. MB managed data acquisition and critically reviewed the manuscript. NMP revised the clinical pathway, contributed to the study design, provided clinical and antimicrobial stewardship expertise, contributed to intervention design, and critically reviewed the manuscript. All authors are responsible for the content of the manuscript. NMP takes responsibility for the paper as a whole. |
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| Data sharing statement: The entire deidentified data set, data dictionary, and analytic code for this investigation are available on request, from the date of article publication, by contacting Nicole Poole, MD, MPH, at nicole.poole@childrenscolorado.org. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Drs. Cotter and Ambroggio receive grant funding from Pfizer, Inc. for an unrelated study. The other authors have no conflict of interest to report. This work was supported by the Agency for Healthcare Research and Quality [grant number 1K08HS029693-01A1 to J.C.]. The other authors received no external funding that contributed to this work. The contents are the authors’ sole responsibility and do not necessarily represent official views of the funding agencies. |
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| Presentation information: Poster abstract presented October 14, 2023, at IDWeek, Boston, MA. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 86 - N° 6
P. 586-593 - décembre 2025 Retour au numéro
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