Adhering to guidelines for antibiotic treatment of acute chest syndrome in children with sickle cell disease (SCD) is associated with reduced readmission rates, according to a retrospective cohort study.

Acute chest syndrome is a leading cause of hospitalization and death in children and adults with SCD. Guidelines recommend empiric antibiotic therapy, typically with an intravenous cephalosporin and an oral macrolide antibiotic, although convincing data are lacking.

Dr. David G. Bundy from Medical University of South Carolina, in Charleston, and colleagues used data from the Children’s Hospital Association Pediatric Health Information System to determine whether adherence to such guidelines was associated with lower readmission rates for acute chest syndrome and overall.

Of 14,480 hospitalizations (for 7,178 children with acute chest syndrome), 73.6 percent involved provision of guideline-adherent antibiotics (macrolide plus cephalosporin). Cephalosporins alone were used in 11.6 percent of hospitalizations and macrolides alone in 8.3 percent; the remaining 6.6 percent of hospitalizations involved neither antibiotic (including 4.4 percent with no antibiotics).

Use of guideline-adherent antibiotics varied from about 24 percent to 90 percent across the 41 hospitals included in the study, according to the September 11 JAMA Pediatrics online report.

Readmissions for acute chest syndrome and all-cause readmissions at 7 and 30 days after hospitalization were lowest in the guideline-adherent antibiotic group, second lowest in the group that received parenteral cephalosporins without macrolides, and highest (except for 7-day readmissions for acute chest syndrome) after hospitalizations involving neither antibiotic.

After adjustment for other variables, hospitalizations involving provision of both cephalosporins and macrolides were 29 percent lower for readmissions related to acute chest syndrome and 50 percent lower for all-cause readmissions, compared with hospitalizations involving no antibiotics.

“Current approaches to antibiotic treatment in children with ACS (acute chest syndrome) vary widely, so more robust dissemination and implementation of existing treatment guidelines may reduce readmissions in this high-risk population,” the researchers conclude. “Furthermore, randomized clinical trials of antibiotics for the treatment of ACS in children, perhaps comparing guideline-recommended and narrower (e.g., macrolide-only) regimens for lower risk children, are needed to strengthen the evidence base underpinning current recommendations.”