Deborah Lehman, MD reviewing Shah S et al. Pediatrics 2016 Nov 17.

Intravenous administration of antibiotics postdischarge offers no advantage over oral administration.

Completion of antibiotic therapy following hospital discharge for complicated pneumonia (presence of pleural effusion, empyema, or lung abscess) in children is commonly administered via a peripherally inserted central venous catheter (PICC) line, although oral antibiotics are frequently used for postdischarge therapy completion in other serious bacterial infections.

In a multicenter retrospective cohort study, researchers compared the effectiveness and complication outcomes of intravenous (IV) versus oral antibiotic administration following hospitalization for complicated pediatric pneumonia. They utilized administrative hospital data and medical records for 2123 children (aged ≥2 months and <18 years) discharged with complicated pneumonia from 36 children's hospitals.

Postdischarge antibiotic administration was intravenous in 13% of patients and oral in 87%. The median duration of antibiotic administration was 14 days. Of the 14% of children with an identified pathogenic organism, Streptococcus pneumoniae was most commonly isolated, followed by Staphylococcus aureus (73% methicillin-resistant S. aureus). PICC line complications occurred in 7% of children (thrombosis and dislodgment were most common). After matching children on multiple patient-level characteristics, including receipt and timing of pleural drainage, the rate of treatment failure was similar between patients receiving IV antibiotics and those receiving oral antibiotics.

CITATION(S):

Shah S et al. Intravenous versus oral antibiotics for postdischarge treatment of complicated pneumonia. Pediatrics 2016 Nov 17; [e-pub]. 

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