Intravenous vs. Oral Antibiotics for Ambulatory Treatment of Pediatric Osteomyelitis

Robert S. Baltimore, MD

For postdischarge management of acute osteomyelitis, oral antibiotics were as effective as intravenous ones and were associated with fewer treatment-associated complications.

In the U.S., most children with acute osteomyelitis are treated for a short time in the hospital with intravenous (IV) antibiotics, followed by 4 to 6 weeks of home antibiotic therapy administered orally or intravenously via a peripherally inserted central catheter (PICC). PICCs carry risk for complications such as secondary infection. In a recent retrospective cohort study conducted at 36 U.S. children's hospitals, researchers compared the effectiveness and adverse outcomes of postdischarge antibiotic therapy administered by these routes.

Data were analyzed for 2060 children aged 2 months to <18 years who were discharged between January 2009 and December 2012 after hospitalization for acute osteomyelitis. Outcomes were determined using information obtained from medical-record review. The proportion of patients treated via PICC varied across hospitals from 0 to 100%. Treatment groups were balanced for confounding variables by propensity-based full matching.

In the unmatched analysis, treatment failure (the primary study endpoint) was seen in 5% of the oral-treatment group and 6% of the IV-treated group; after matching, rates were similar between groups. Adverse drug reactions were reported in <4% of each group; in the matched analysis, the rate was slightly higher in the PICC group. However, 15% of PICC-group participants experienced complications requiring an emergency department visit or rehospitalization.

Citation(s):

Keren R et al. Comparative effectiveness of intravenous vs oral antibiotics for postdischarge treatment of acute osteomyelitis in children. JAMA Pediatr 2014 Dec 15; [e-pub ahead of print].