Department of Pediatrics emergency medicine researcher Lilliam Ambroggio PhD senior-authored a Pediatrics Top 10 article for 2020. The top-10 article--"Antibiotic Use and Outcomes in Children in the Emergency Department With Suspected Pneumonia"--found that among children with suspected community-acquired pneumonia (CAP), the outcomes did not differ between those who were and were not prescribed antibiotics.

The planned secondary analysis from a prospective cohort study measured the association between antibiotic prescription and treatment failure in of 294 children (ages 3 months–18 years) with signs and symptoms of lower respiratory tract infection for whom a CXR was obtained in one tertiary-care pediatric emergency department (ED). 

The primary outcome was treatment failure, which the authors defined as having at least one of the following:
"(1) a return visit with hospitalization for pneumonia within 30 days of discharge, (2) return visit with a change in antibiotics within 30 days of discharge, and (3) parental report of change in antibiotics by a physician at any time between ED discharge and the follow-up phone call, which occurred 7 to 15 days after an ED visit. The secondary outcomes included ED revisits occurring 30 days after enrollment and parent-reported quality-of-life measures 7 to 15 days after discharge from the ED."

The primary exposure was administration of antibiotics and/or receipt of an antibiotic prescription during the ED visit. The investigative team used propensity-score adjustment to account for the large number of clinical confounders associated with the decision to prescribe antibiotics. For each subject, they used multiple variables to calculate a propensity score that represented the probability of receiving antibiotics and/or an antibiotic prescription.

The team found that in a population of children discharged from the ED with CAP, receipt of antibiotics or an antibiotic prescription did not lead to statistical differences in treatment failure or parent-reported adverse effects or quality-of-life measures. The authors concluded that their findings suggest "that opportunities exist to safely manage more children with suspected CAP treated as outpatients without antibiotics."