Lung Ultrasound for Antibiotic Stewardship in Community-Acquired Pneumonia: A Randomized Clinical Trial

What this Trial Is About

Pneumonia is a leading cause of illness and death among children under five years old, often requiring hospitalization. Diagnosing pneumonia is difficult due to the lack of a universally accepted standard, with current guidelines relying on history and physical exam that cannot reliably distinguish pneumonia from other respiratory infections or identify bacterial versus viral causes. This uncertainty can lead to unnecessary antibiotic use. Lung ultrasound has shown promise in diagnosing pneumonia with high sensitivity and specificity but cannot reliably differentiate bacterial from viral causes and may lead to increased antibiotic use due to detection of minor lung changes. This trial aims to evaluate whether lung ultrasound can reduce antibiotic prescriptions in children with suspected pneumonia compared to standard care. Children aged 3 to 10 years presenting with signs of lower respiratory tract infection and stable clinical status are randomized to either a lung ultrasound group or a standard care group. In the lung ultrasound group, ultrasound is performed immediately after clinical assessment, while the control group receives standard care based on clinical evaluation with optional chest X-ray and blood tests if needed. Clinicians may request chest X-rays in both groups as appropriate, and antibiotic decisions remain at the treating physician's discretion. The study also compares how often lung ultrasound influences clinical decisions and its diagnostic accuracy compared to traditional methods. Participants undergo routine evaluations including history, physical exam, and lung ultrasound if assigned. Data on pneumonia likelihood and antibiotic prescription willingness are collected at multiple decision points using rating scales. Follow-up includes a call 5 to 7 days after discharge to monitor progress and antibiotic use. Outcomes measured include antibiotic use within 7 days, hospital admissions, emergency department stay length, and unscheduled healthcare visits. An expert panel reviews clinical data for final diagnosis. Data are securely recorded with patient privacy maintained. The study aims to clarify if lung ultrasound can improve pediatric pneumonia management and reduce unnecessary antibiotic use without compromising care.

Lung Ultrasound for Guiding Antibiotic Use in Pediatric Pneumonia