Intravenous Versus Oral Antibiotics for Postdischarge Treatment of Complicated Pneumonia
Postdischarge treatment of complicated pneumonia includes antibiotics administered intravenously via a peripherally inserted central venous catheter (PICC) or orally. Antibiotics administered via PICC, although effective, may result in serious complications. We compared the effectiveness and treatme...
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Published in | Pediatrics (Evanston) Vol. 138; no. 6 |
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Main Authors | , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
01.12.2016
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Abstract | Postdischarge treatment of complicated pneumonia includes antibiotics administered intravenously via a peripherally inserted central venous catheter (PICC) or orally. Antibiotics administered via PICC, although effective, may result in serious complications. We compared the effectiveness and treatment-related complications of postdischarge antibiotics delivered by these 2 routes.
This multicenter retrospective cohort study included children ≥2 months and <18 years discharged with complicated pneumonia between 2009 and 2012. The main exposure was the route of postdischarge antibiotic administration, classified as PICC or oral. The primary outcome was treatment failure. Secondary outcomes included PICC complications, adverse drug reactions, other related revisits, and a composite of all 4 outcomes, termed "all related revisits."
Among 2123 children, 281 (13.2%) received antibiotics via PICC. Treatment failure rates were 3.2% among PICC and 2.6% among oral antibiotic recipients and were not significantly different between the groups in across-hospital-matched analysis (matched odds ratio [OR], 1.26; 95% confidence interval [CI], 0.54 to 2.94). PICC complications occurred in 7.1%. Adverse drug reactions occurred in 0.6% of children; PICC antibiotic recipients had greater odds of adverse drug reaction in across hospital matched analysis (matched OR, 19.1; 95% CI, 4.2 to 87.3). The high rate of PICC complications and differences in adverse drug reactions contributed to higher odds of the composite outcome of all related revisits among PICC antibiotic recipients (matched OR, 4.71; 95% CI, 2.97 to 7.46).
Treatment failure rates between PICC and oral antibiotics did not differ. Children with complicated pneumonia should preferentially receive oral antibiotics at discharge when effective oral options are available. |
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AbstractList | Postdischarge treatment of complicated pneumonia includes antibiotics administered intravenously via a peripherally inserted central venous catheter (PICC) or orally. Antibiotics administered via PICC, although effective, may result in serious complications. We compared the effectiveness and treatment-related complications of postdischarge antibiotics delivered by these 2 routes.
This multicenter retrospective cohort study included children ≥2 months and <18 years discharged with complicated pneumonia between 2009 and 2012. The main exposure was the route of postdischarge antibiotic administration, classified as PICC or oral. The primary outcome was treatment failure. Secondary outcomes included PICC complications, adverse drug reactions, other related revisits, and a composite of all 4 outcomes, termed "all related revisits."
Among 2123 children, 281 (13.2%) received antibiotics via PICC. Treatment failure rates were 3.2% among PICC and 2.6% among oral antibiotic recipients and were not significantly different between the groups in across-hospital-matched analysis (matched odds ratio [OR], 1.26; 95% confidence interval [CI], 0.54 to 2.94). PICC complications occurred in 7.1%. Adverse drug reactions occurred in 0.6% of children; PICC antibiotic recipients had greater odds of adverse drug reaction in across hospital matched analysis (matched OR, 19.1; 95% CI, 4.2 to 87.3). The high rate of PICC complications and differences in adverse drug reactions contributed to higher odds of the composite outcome of all related revisits among PICC antibiotic recipients (matched OR, 4.71; 95% CI, 2.97 to 7.46).
Treatment failure rates between PICC and oral antibiotics did not differ. Children with complicated pneumonia should preferentially receive oral antibiotics at discharge when effective oral options are available. |
Author | Rao, Suchitra Shah, Samir S Clohessy, Caitlin Williams, Derek J Bryan, Matthew Rangel, Shawn J Srivastava, Rajendu Wu, Gong Keren, Ron Wu, Susan Colvin, Jeffrey D Miller, Christopher Hall, Matthew Localio, Russell Samady, Waheeda Cross, Cynthia |
Author_xml | – sequence: 1 givenname: Samir S surname: Shah fullname: Shah, Samir S email: samir.shah@cchmc.org organization: Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio – sequence: 2 givenname: Rajendu surname: Srivastava fullname: Srivastava, Rajendu organization: Institute for Healthcare Delivery Research and Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, Utah – sequence: 3 givenname: Susan surname: Wu fullname: Wu, Susan organization: Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California – sequence: 4 givenname: Jeffrey D surname: Colvin fullname: Colvin, Jeffrey D organization: Division of General Academic Pediatrics, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri – sequence: 5 givenname: Derek J surname: Williams fullname: Williams, Derek J organization: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee – sequence: 6 givenname: Shawn J surname: Rangel fullname: Rangel, Shawn J organization: Harvard Medical School, Boston, Massachusetts – sequence: 7 givenname: Waheeda surname: Samady fullname: Samady, Waheeda organization: Northwestern Feinberg School of Medicine, Chicago, Illinois – sequence: 8 givenname: Suchitra surname: Rao fullname: Rao, Suchitra organization: Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado – sequence: 9 givenname: Christopher surname: Miller fullname: Miller, Christopher organization: Division of Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah – sequence: 10 givenname: Cynthia surname: Cross fullname: Cross, Cynthia organization: Department of Pediatrics, University of Tennessee College of Medicine, Memphis, Tennessee – sequence: 11 givenname: Caitlin surname: Clohessy fullname: Clohessy, Caitlin organization: Divisions of Hospital Medicine and – sequence: 12 givenname: Matthew surname: Hall fullname: Hall, Matthew organization: Children's Hospital Association, Overland Park, Kansas – sequence: 13 givenname: Russell surname: Localio fullname: Localio, Russell organization: Department of Biostatistics and Epidemiology, Perlman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania – sequence: 14 givenname: Matthew surname: Bryan fullname: Bryan, Matthew organization: Department of Biostatistics and Epidemiology, Perlman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania – sequence: 15 givenname: Gong surname: Wu fullname: Wu, Gong organization: Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and – sequence: 16 givenname: Ron surname: Keren fullname: Keren, Ron organization: Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania |
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References | 28500063 - Evid Based Med. 2017 Jun;22(3):105 |
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SubjectTerms | Administration, Intravenous Administration, Oral Adolescent Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - adverse effects Catheterization, Peripheral - adverse effects Child Child, Preschool Cohort Studies Humans Infant Patient Discharge Pneumonia - drug therapy Retrospective Studies Treatment Failure |
Title | Intravenous Versus Oral Antibiotics for Postdischarge Treatment of Complicated Pneumonia |
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