Children Recovering from Complex Pneumonia Best Treated with Oral Antibiotics, Study Says

Children Recovering from Complex Pneumonia Best Treated with Oral Antibiotics, Study Says

Children with complicated pneumonia do well with oral antibiotics after being discharged from a hospital and might not need to continue intravenous treatment, researchers reported in what they called the first multi-center project looking at post-hospital antibiotic use in children with complicated pneumonia.

The study, “Intravenous Versus Oral Antibiotics for Postdischarge Treatment of Complicated Pneumonia” published in the journal Pediatrics, also favored oral antibiotic treatment at home as safer than intravenous treatment when effective oral therapies exist.

Community-acquired pneumonia is the most common, serious childhood infection requiring hospitalization, and up to 15 percent of those hospitalized develop pleural effusion or empyema (i.e., complicated pneumonia).

Antibiotics are typically administered intravenously during hospitalization, and can be continued either orally or intravenously via a peripherally inserted central catheter (PICC) after discharge. Typically, patients stay on antibiotics one to three weeks after hospital discharge to treat residual infection.

In a collaborative effort, a research team led by clinicians at the Cincinnati Children’s Hospital Medical Center, part of the Pediatric Research in Inpatient Settings Network, conducted a retrospective analysis of children, ages 2 months and 18 years, discharged with complicated pneumonia from 36 hospitals between 2009 and 2012. The goal was to compare the effectiveness and treatment-related complications of at-home antibiotics delivered via PICC or orally.

Researchers found that, while PICC use is not very common overall, there was considerable variation in its use after discharge across the 36 hospitals included in the analysis.

Of the 2,123 children in the study, 281 (13.2 percent) received antibiotics at home via PICC. Treatment failure rates were not statistically significant between PICC and oral antibiotic use, researchers found, with a 3.2 percent treatment failure observed among those using PICC, and 2.6 percent among those receiving oral antibiotics.

“PICC line complications can be serious, resulting in hospital readmission, additional procedures, and more medications, as well as missed work or school,” Samir Shah, MD, MSCE, the study’s lead author and director of Hospital Medicine at Cincinnati Children’s, said in a news release. “It’s not surprising that children and families would rather not use PICC lines. Our findings, which provide compelling evidence to support the use of oral antibiotics for children with complex pneumonia, will contribute to safer care for children across the country.”

PICC-related complications occurred in 7.1 percent of the children, while adverse drug reactions were seen in 0.6 percent of children given oral antibiotics.

“Children with complicated pneumonia should preferentially receive oral antibiotics at discharge when effective oral options are available,” the researchers concluded.

National treatment guidelines do not call for the use oral antibiotics following hospital discharge, but they do highlight the risk of giving antibiotics intravenously.

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