by Ricardo A. Quinonez, M.D., FAAP
Two recent studies by pediatric hospitalists support
recommendations from the Infectious Diseases Society of America (IDSA) and Pediatric Infectious Diseases Society (PIDS) to use narrow spectrum
antibiotics rather than wider spectrum cephalosporins
to treat children hospitalized with uncomplicated
community acquired pneumonia (CAP).
The IDSA-PIDS guidelines on the evaluation and
management of CAP in children were published in
2011 (Bradley JS, et al. Clin Infect Dis. 2011;53:e25-
e76) and subsequently were endorsed by the Academy. While they represent a great step forward in
standardizing the care of one of the most common
illnesses in childhood, some of the recommendations
lack solid evidence.
One such recommendation is to use narrow spec-
trum antibiotics such as penicillin or ampicillin when
treating children admitted for uncomplicated CAP,
rather than commonly used wider spectrum
cephalosporins such as ceftriaxone or cefotaxime.
This was a strong recommendation supported by
moderate quality evidence. Two recent studies give
further support to this recommendation for inpatient
care (Williams DJ, et al. Pediatrics. 2013;132:e1141-
e1148 and Queen MA, et al. Pediatrics. 2014;133:
Williams and colleagues used the Pediatric Health
Information System database to compare the out-
comes of 15,564 children ages 6 to 18 months hos-
pitalized for CAP in 43 children’s hospitals. The
primary outcome of the study was length of stay;
secondary outcomes included transfer to higher level
of care, readmission within the first 14 days post-
discharge and total costs.
The study population was divided into two main
groups: those who received broad spectrum antibi-
When the bully is a coach:
What pediatricians and
parents can do
by Kody A. Moffatt, M.D., M.S., FAAP
Bullying behavior in school and sports remains
a pervasive problem in our society. Typically, the
offender is a peer. However, as a recent article
highlights, the offender often is a trusted adult
such as an athletic coach (Swigonski NL, et al.
Bullying generally is defined as a systematic
abuse of power in which a stronger individual
exhibits a pattern of intimidating behavior against
someone weaker or less powerful. Bullying can
impair victims’ social and emotional development
and cause substantial harm to their mental health.
When bullying occurs in an athletic setting, those
harmful effects are augmented by the stress kids
often feel due to competition. Bullying behavior
such as demeaning, shaming and name-calling
remains a common aspect of coaching in sports
at any level.
The article discusses data collected on more
than 6,000 young adults who were interviewed
about their sports experiences during adolescence.
See Antibiotics, page 4
See Bullying, page 4
In this issue
Periodicity Schedule updated, online
The revised AAP Periodicity Schedule of recommended
screenings and preventive care has changes that will affect
daily practice, including routine screens for depression and
an additional screening for dyslipidemia. Page 10
P h o t o c o u r t e s y o f S c o t t M . N e e d l e , M . D . , F A A P If your office is devastated by a disaster, well-meaning advice such as exercising, eating well and taking time off to recharge may not be helpful. The Academy convened a group of experts to come up with practical strategies to assist practitioners in communities recovering from calamities. See article on Page 8.
When disaster strikes,
self-care often is neglected
Old foe, old remedy
Studies support use of older, inexpensive
antibiotics for community acquired pneumonia
Emotional harm and verbal misconduct ranked
high among incidents reported by young adults
who played sports during adolescence. A new
study details defensive techniques used by
coaches who engage in bullying or manipulative
behavior and offers prevention tips.
Volume 35 • Number 3 • March 2014