Oral Antibiotics as Effective as IV Antibiotics for Children after Being Discharged from the Hospital, Study Finds

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Faced with the uncertainty of becoming your child’s caregiver, parents can now be assured that oral antibiotics, the simpler method to administer antibiotics, is as effective as the more complicated intravenous (IV) ­route.

Scientific evidence from three different studies funded by the Patient-Centered Outcomes Research Institute (PCORI) shows how oral antibiotics are as good as IV antibiotics delivered directly to the blood stream using a peripherally inserted central catheter (PICC line).

The advantage of antibiotics delivered orally is proven simple when compared with the PICC method that is complex and often rife with infectious, blood clotting, and mechanical complications, that can extend a child’s illness.

Pediatric antibiotic studies include:

  1. Comparative Effectiveness of Intravenous vs. Oral Antibiotics for Post Discharge Treatment of Acute Osteomyelitis in Children
  2. Intravenous Versus Oral Antibiotics for Postdischarge Treatment of Complicated Pneumonia
  3. Intravenous Versus Oral Antibiotics for the Prevention of Treatment Failure in Children With Complicated Appendicitis

The study investigating acute osteomyelitis compared the effectiveness and adverse outcomes of children and adolescents being treated with antibiotics. Osteomyelitis is a rare, but serious bacterial infection that first requires hospitalization, followed by 4 to 6 weeks of antibiotic treatments at home.

Results from the cohort study demonstrated children hospitalized with osteomyelitis and discharged to complete a course of antibiotic therapy at home via the oral method had similar rates of failure when compared to the PICC line method.  

However, there was a higher frequency of PICC-related complications requiring emergency department revisits and/or rehospitalization. Children being treated with the PICC line method had a 14 percent higher chance of adverse events when compared with children using the oral method.

Chris Miller, MD, Intermountain Primary Children’s Hospital, and University of Utah Health Care says, “These studies show it is safe to send patients home on oral antibiotics in three common pediatric diagnoses:  complicated pneumonia, ruptured appendicitis, and osteomyelitis. Prior to the studies, many patients were being discharged home with PICCs to complete their therapy.” 

Co-leader, Raj Srivastava, MD, MPH, Assistant Vice President of Research at Intermountain Healthcare, and Dr. Miller were instrumental in coordinating data particularly for the Osteomyelitis study. Data was collected from January 1, 2009, through December 31, 2012, from 36 children’s hospitals, including Intermountain Primary Children’s Hospital, and the Pediatric Health Information System® database of the Children’s Hospital Association.

The study ran through the Pediatric Research in Inpatient Settings (PRIS) Network – a group of more than 100 hospitals across the U.S. and Canada. Leadership of PRIS is from seven large children’s hospitals, including Intermountain’s Primary Children’s Hospital.

From the aggregated data, a retrospective cohort study compared outcomes on 2060 children being treated for osteomyelitis, of which 1005 received oral antibiotics at discharge and 1055 received PICC-administered antibiotics.

Dr. Srivastava says, “One hospital cannot answer all the questions about treating disease, but as a group, we can find answers. It is through collaborative research we can improve the care and safety of our patients.”

Following the osteomyelitis study, Dr. Miller took on the role as the Primary Children’s Hospital PRIS site lead. Dr. Miller says, “As a pediatric hospitalist, I’m always exploring ways to improve the care of our patients using current evidence-based medicine. As a participant in clinical research, I’m given the rare opportunity to effect change in the pediatric world.”

Through the PRIS network, Dr. Miller is conducting a new study in collaboration with several other children’s hospitals to evaluate the use of electrolytes in the inpatient setting. The study is looking at variation across pediatric hospitals when ordering electrolytes. “We are hoping to reduce the use of electrolyte panels when they are not clinically indicated,” says Dr. Miller. An electrolyte panel is a blood test that measures the levels of electrolytes and carbon dioxide in a patient’s blood.

To find out more about Intermountain Healthcare Research and the advancement of medical knowledge in many clinical areas visit intermountainresearch.org.