Jeffery Gerber, pediatric infectious disease and stewardship expert, and Kathleen Chiotos, researcher focused on pediatric infectious diseases and stewardship, discuss antibiotic use in children with medical complexity. They explore why these children are often excluded from guidelines. They cover study design choices, time-series methods, findings on antibiotic choice and duration, and recommendations for more inclusive future research.
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insights INSIGHT
Feedback Reports Change Group Behavior Beyond Targets
Clinician feedback reports act as a group-level behavior change tool that can influence care beyond the patients included in the reports.
Although children with medical complexity (CMC) were excluded from reports, the same clinicians changed prescribing across their entire patient panel, creating an off-target effect.
insights INSIGHT
No Clear Harm Signal Applying Stewardship To CMC
Post hoc time-series analysis showed an increase in appropriate antibiotic choice for CMC after the intervention and a non-significant increase in appropriate duration.
The authors interpret these as hypothesis-generating results suggesting no clear signal of harm from applying stewardship metrics to many CMC.
volunteer_activism ADVICE
Define CMC Subgroups For Clearer Study Results
Include more narrowly defined CMC subgroups in future studies instead of the broad CCC scheme to get actionable conclusions.
For example, focus on children with neurologic impairment to study aspiration concerns and device-related risks separately.
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In this Complex Care Journal Club podcast episode, Drs. Kathleen Chiotos and Jeffrey Gerber discuss a post hoc time-series analysis of clinician feedback reports and antibiotic prescribing for community-acquired pneumonia in children with medical complexity (CMC). They describe why children with medical complexity are often excluded from guideline-based interventions, what the data suggest about antibiotic choice and duration in this population, and next steps to design studies that include all children.
SPEAKERS
Kathleen Chiotos, MD, MSCE
Associate Professor of Anesthesiology and Critical Care
University of Pennsylvania, Children's Hospital of Philadelphia
Jeffery Gerber, MD, PhD
Professor of Pediatrics and Epidemiology
University of Pennsylvania School of Medicine;
Children's Hospital of Philadelphia
HOST
Kristina Malik, MD
Assistant Professor of Pediatrics,
University of Colorado School of Medicine
Medical Director, KidStreet
Pediatrician, Special Care Clinic,
Children's Hospital Colorado
DATE
Initial publication date: February 17, 2026.
JOURNAL CLUB ARTICLE
Chiotos K, Dutcher L, Grundmeier RW, Szymczak JE, Lautenbach E, Neuhauser MM, Hicks LA, Hamilton KW, Li Y, Muller BM, Meyahnwi D, Congdon M, Kane E, Hart J, Utidjian L, Cressman L, Jaskowiak-Barr A, Gerber JS. Off-target Impact of Clinician Feedback Reports on Antibiotic Use in Children With Medical Complexity Hospitalized With Community-Acquired Pneumonia. J Pediatric Infect Dis Soc. 2025 Oct 2;14(10):piaf089. doi: 10.1093/jpids/piaf089. PMID: 41051365.
OTHER ARTICLES REFERENCED
Chiotos K, Dutcher L, Grundmeier RW, Meyahnwi D, Lautenbach E, Neuhauser MM, Hicks LA, Hamilton KW, Li Y, Szymczak JE, Muller BM, Congdon M, Kane E, Hart J, Utidjian L, Cressman L, Jaskowiak-Barr A, Gerber JS. Impact of Clinician Feedback Reports on Antibiotic Use in Children Hospitalized With Community-acquired Pneumonia. Clin Infect Dis. 2025 Feb 24;80(2):263-270. doi: 10.1093/cid/ciae593. PMID: 39656188; PMCID: PMC12120840.
Feudtner C, Feinstein JA, Zhong W, Hall M, Dai D. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr. 2014 Aug 8;14:199. doi: 10.1186/1471-2431-14-199. PMID: 25102958; PMCID: PMC4134331.
TRANSCRIPT
https://cdn.bfldr.com/D6LGWP8S/as/bgxn4mqgk45zjxhxpxgxf3px/Chiotos_and_Gerber_podcast_2-13-26
Clinicians across healthcare professions, advocates, researchers, and patients/families are all encouraged to engage and provide feedback! You can recommend an article for discussion using this form: https://forms.gle/Bdxb86Sw5qq1uFhW6.
Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu
CITATION
Chiotos K, Gerber JS, Malik K. Evidence for Everyone: Studying Antibiotic Use for Pneumonia in Children With Medical Complexity. 2/2026. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/evidence-for-everyone-studying-antibiotic-use-for-pneumonia-in-children-with-medical-complexity.
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