Comprehensive Summary
In their article, Weber et al. (2025) evaluated the impact of both an order set and a revised EHR-integrated pathway on adherence to recommended treatment for pediatric community acquired pneumonia (CAP). According to the American Academy of Pediatrics (AAP), CAP in children should be treated with a five-day course of amoxicillin; this study sought to increase adherence to this guideline. This study identified 3,553 pediatric CAP cases across 4 EDs and 5 urgent care centers. Of these, 2,605 cases utilized a pre-order set, while 890 used the EHR post-pathway revision. Primary outcomes included the proportion of patients receiving amoxicillin, the rate of azithromycin prescription, and the percentage of cases prescribed antibiotics for five days or fewer. Among patients treated using the pre-order set, there were no significant changes in primary outcomes. After implementation of post-pathway revision all primary outcomes improved: amoxicillin monotherapy rates increased (60.6% to 70.9%), azithromycin prescription decreased (12.5% to 3.7%), and antibiotic courses of 5 days or fewer rose from 2.0% to 66.1%. Overall, the post-pathway revision effectively increased adherence to treatment guidelines for pediatric CAP cases in both the ED and in urgent care settings.
Outcomes and Implications
Pediatric CAP accounts for over 1.1 million antibiotic prescriptions annually, and in such cases the APP recommends a five-day course of amoxicillin. However, azithromycin is currently prescribed in nearly half of these cases, contrary to recommended guidelines. This deviation increases the risk of adverse events and contributes to inappropriate antibiotic use. Implementation of Weber et al. 's post-pathway revision improved adherence to AAP guidelines, promoting a more appropriate and standardized treatment of pediatric CAP in the ED and in urgent care centers.