For the past several years, pediatric pharmacist Bill Wilson, PharmD, of UNC Children’s Hospital has worked to ensure that children sick with community-acquired pneumonia (CAP) get the best available treatment. Pneumonia is a top cause of child deaths globally, and, in the US, the majority of children hospitalized for it are under five years of age. Because CAP is most commonly caused by a virus, bacteria, or a combination of these, it is critical to ensure that antibiotics and other antimicrobials are selected with precision to address the root cause of the lung infection. Widespread use of effective childhood vaccines that protect against certain bacterial pneumonias have made bacterial causes of pneumonia less common. However, childhood pneumonia from all causes remains common.
In mid-2019, Wilson and his colleague Zachary Willis, MD, MPH, an infectious diseases pediatrician, both part of the Carolina Antimicrobial Stewardship Program, led a team of pediatric experts to develop an antimicrobial treatment guideline for CAP. The guideline aids providers during the selection of the most appropriate antimicrobial for their patients, depending on their unique circumstances. Wilson and Willis convened a multidisciplinary team that included clinicians trained in infectious diseases, critical care, pulmonology, hospital medicine, surgery, and interventional radiology to assist in developing CAP treatment and management pathways. Wilson and Willis partnered with Pharmacy Analytics to create a tool to help them assess how well it is working.
“Our previous collaboration with Pharmacy Analytics to develop a tool to assess compliance with the pediatric appendicitis guideline helped us lay the groundwork for our community-acquired pneumonia tool,” Wilson said. “Because CAP is more complex to accurately capture, we anticipate ongoing refinement of this tool.”
In 2020, Wilson, Willis, and their pediatric colleagues embarked on the second phase of their work. The final product is a new pediatric community-acquired pneumonia clinical practice guideline that was approved by the UNC Medical Center’s Anti-infective Sub-committee in March 2021. In addition to guidance on antimicrobial therapy, it synthesizes the latest evidence to guide diagnostic evaluation, procedural management, and disposition of children with CAP. This collaborative effort has allowed for constructive discussions about the complex care provided for pediatric patients with an antimicrobial stewardship lens throughout.
Wilson and Willis plan to refine the monitoring tool to reflect recommendations from this clinical guideline to assess its uptake. “Because of the effectiveness of pandemic prevention measures, we’ve seen fewer cases of CAP at UNC Children’s this year. Once more children return to daycare and in-person school in the fall, we anticipate the new guideline will be put to use as we see pneumonia rates rise,” Willis explained. “We hope the guideline will improve outcomes for our youngest patients.”