Intravenous Versus Oral Antibiotics for Postdischarge Treatment of Complicated Pneumonia.

TitleIntravenous Versus Oral Antibiotics for Postdischarge Treatment of Complicated Pneumonia.
Publication TypeJournal Article
Year of Publication2016
AuthorsShah SS, Srivastava R, Wu S, Colvin JD, Williams DJ, Rangel SJ, Samady W, Rao S, Miller C, Cross C, Clohessy C, Hall M, Localio R, Bryan M, Wu G, Keren R
Corporate AuthorsPediatric Research in Inpatient Settings Network
JournalPediatrics
Volume138
Issue6
Date Published2016 Dec
ISSN1098-4275
Abstract

BACKGROUND AND OBJECTIVES: 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.

METHODS: 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."

RESULTS: 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).

CONCLUSIONS: 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.

DOI10.1542/peds.2016-1692
Alternate JournalPediatrics
PubMed ID27940695