Impact of clinical decision support on empirical antibiotic prescribing for children with community‐acquired pneumonia

Aim To assess the impact of a computerised clinical decision support system (CDSS) on antibiotic use in hospitalised children with a presumptive diagnosis of uncomplicated community‐acquired pneumonia (CAP). Methods Codes associated with lower respiratory tract infection were used to identify cases of presumed uncomplicated CAP requiring admission to a tertiary paediatric hospital. Random sampling of the periods between 1 October 2010 and 30 September 2012 (pre‐CDSS) and 1 October 2012 and 30 September 2014 (post‐CDSS) determined the sequence of case assessment by two independent investigators. Initial antibiotic therapy, associated CDSS approvals and documented signs of clinical deterioration prior to antibiotic decision‐making were recorded. Results Statistically significant differences between cases pre‐ and post‐CDSS implementation were minimal. High fever was observed in 57.5% (77/134) cases pre‐CDSS and 45.8% (49/107) cases post‐CDSS ( P = 0.07). Supplemental oxygen was used in 30.6% pre‐CDSS and 54.2% post‐CDSS cases ( P < 0.001). Narrow‐spectrum penicillins were prescribed most often, with no statistically significant change post‐CDSS implementation (81.3% pre‐CDSS, 77.6% post‐CDSS, P = 0.47). Macrolides were used consistently throughout the study period (53.7% pre‐CDSS, 61.7% post‐CDSS; P = 0.21). Conclusion CDSS implementation did not reduce already low rates of broad‐spectrum antibiotic use for uncomplicated CAP.