Article Text
Abstract
Background In 2020, updated South African guidance on management of children with community-acquired pneumonia were published by the South African Thoracic Society. These guidelines recommend intravenous co-amoxiclav as first-line therapy for children hospitalised with World Health Organisation (WHO) defined severe pneumonia. We evaluated how this guideline change impacted on participant enrollment into the PediCAP Trial (https://projectpedicap.org/) at the Trial site in Johannesburg, as receipt of intravenous co-amoxiclav is an exclusion criterion for PediCAP enrollment.
Methods A line list of all paediatric admissions to the Johannesburg PediCAP site is maintained, to facilitate screening for age-eligible paediatric patients with respiratory illness on weekdays. The total number of children hospitalised at the site, the total number of respiratory admissions, and the characteristics of children screened for PediCAP were assessed descriptively.
Results From 15 July 2021 to 15 May 2023, 11,998 children were hospitalised at the study site. On PediCAP screening days, 4,829 age-eligible children were hospitalised, 2,377 (49.2%) of whom had respiratory admission diagnoses. Five-hundred, twenty-seven children underwent point-of-care C-reactive protein (CRP) testing for eligibility screening into PediCAP and 239 (45.4%) were enrolled. A clinician decision to initiate intravenous co-amoxiclav was a common reason for non-eligibility (in 316 [13.1%] of 2,417 children). Formal CRP levels were significantly higher in children enrolled into PediCAP compared to those treated with intravenous co-amoxiclav (median 51.0 mg/L [Interquartile range (IQR), 29.0–111.0] vs. 18.0 mg/L [IQR, 5.0–57.5]; corrected P-value<0.001).
Conclusion National guideline recommendations to use intravenous co-amoxiclav as first-line therapy for children hospitalised with severe pneumonia have impacted participant recruitment into PediCAP at the Trial site in Johannesburg. Significantly lower CRP levels in children treated empirically with intravenous co-amoxiclav indicates a disparity between clinician prescribing and the likely aetiology of disease in children hospitalised with severe pneumonia at the study site, warranting optimisation of antimicrobial stewardship practice.