Children Hospitalized With Pneumonia Who Complete Oral Antibiotic Treatment Without Complications

OBJECTIVE: While initial oral antibiotics are likely as effective as intravenous (IV) antibiotics for most children hospitalized with community-acquired pneumonia (CAP), most still receive IV therapy. We evaluated factors associated with doing well with initial oral antibiotics among children hospitalized with CAP. METHODS: We performed a multicenter retrospective cohort study of children hospitalized with CAP who were started on oral antibiotics at 4 children's hospitals between 2014 and 2020. We performed multivariable logistic regression to evaluate the association between hospital site and patient-level factors and doing well with oral antibiotics, defined as those who remained on oral antibiotics throughout the hospitalization, did not have escalation of care during the hospitalization, and did not have readmissions or emergency department revisits within 7 days of discharge. RESULTS: Among 419 children who received initial oral antibiotics, 76% (n = 317) did well with this regimen (ie, remained on orals and did not have escalation or revisits). Of those who did not do well (n = 102), 80% (n = 82) switched to IV antibiotics but had no escalation of care or revisits. In multivariable analyses, there were no patient-level factors associated with doing well with initial oral antibiotics, and only hospital site was statistically significant. CONCLUSIONS: Most children hospitalized with CAP given initial oral antibiotics continued oral therapy and did not have escalation of care or return visits. Switching from oral to IV antibiotics may be based more on nonpatient level factors (eg, clinician preference) than patient-level factors, although prospective studies are needed.