Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For pediatric patients with community acquired pneumonia admitted to the hospital what is the best antibiotic regiment?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Pediatric patients 2 months to 17 years of age admitted to the hospital with community acquired pneumonia

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Patients admitted to non-critical care units of the hospital

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Improvement of symptoms with the most cost-effective drug choice.

Describe any health-related risks, side effects, or harms that you are concerned about.

None, all of the antibiotics that would be studied are known to be effective for community acquired pneumonia. Side effects would be those common to antibiotics such as diarrhea, allergies, and others particular to each drug

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Infectious diseases, including HIV/AIDS
• Pulmonary disease/asthma

AHRQ Priority Populations

• Children

Federal Health Care Program

• Medicaid
• Medicare
• State Children's Health Insurance Program (SCHIP)
• Other

Importance

Describe why this topic is important.

Pediatric community acquired pneumonia is the number one discharge diagnosis for inpatient pediatrics after "live births". Although the use of antibiotics is common for community acquired pneumonia, the most cost-effective antibiotic regiment for children admitted to the hospital is unknown. The use of the least wide-spectrum antibiotics that could be determined through clinical trials to be effective, would offer significant cost-savings to hospitals and health care practitioners. If the least wide-spectrum antibiotics are shown to be as effective as more costly wide-spectrum antibiotics, it would aid in the development of cost-effective evidence based guidelines for management of pediatrics patients with this condition. Stuartship of antibiotics would be another benefit as wide spectrum antibiotics would be used only in cases of severe or complicated disease, thus preventing rapid development of resistance to these drugs

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

I have been involved in the development of clinical guidelines at my institution for community acquired penumonia so I'm well versed on the available evidence in this topic. I have also had a chance to review the soon to be published national guidelines on pediatric community acquired pneumonia and thus I am highly aware of the paucity of evidence as far as the use of antibiotics for this common condition.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

If yes, please explain:

Yes, a wide spectrum of care exists. Many institutions use penicillin type antibiotics to treat pneumonia and many use wide spectrum antibiotics such as third generation cephalosporins or vancomycin and even newer antibiotics such as linezolid. However no one has compared these in clinical trials to each other so the evidence for or against using a particular antibiotic is lacking.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Being pediatric hospitalist, knowing which antibiotic is the most cost-effective antibiotic for pneumonia in children would have have a tremendous impact for my group as this is the most common inpatient condition we encounter. The implications and impact however would be national in scope.

Describe the timeframe in which an answer to your question is needed.

National guidelines will soon be published for this condition and although they address some questions the recommendations for antibiotics that are made lack quality evidence and are mostly expert opinion. This question requires an answer within 1 to 2 years to adequately guide pediatricians.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Children are a vulnerable population in which many clinical question including this one have yet to be answered. Variation in care benefits no one, especially for such common conditions as pneumonia.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Being pediatric hospitalist, knowing which antibiotic is the most cost-effective antibiotic for pneumonia in children would have have a tremendous impact for my group as this is the most common inpatient condition we encounter. The implications and impact however would be national in scope.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program

Google search for Comparative Effectiveness Research