TY - JOUR
T1 - Intravenous versus oral antibiotics for postdischarge treatment of complicated pneumonia
AU - Shah, Samir S.
AU - Srivastava, Rajendu
AU - Wu, Susan
AU - Colvin, Jeffrey D.
AU - Williams, Derek J.
AU - Rangel, Shawn J.
AU - Samady, Waheeda
AU - Rao, Suchitra
AU - Miller, Christopher
AU - Cross, Cynthia
AU - Clohessy, Caitlin
AU - Hall, Matthew
AU - Localio, Russell
AU - Bryan, Matthew
AU - Wu, Gong
AU - Keren, Ron
AU - Pediatric Research in Inpatient Settings Network
N1 - Funding Information:
Research reported in this publication was funded through a Patient-Centered Outcomes Research Institute (PCORI) award (4252940000). The statements in this publication are solely the responsibility of the authors and do not necessarily represent the views of PCORI, its Board of Governors, or its Methodology Committee.
PY - 2016/12
Y1 - 2016/12
N2 - BACKGROUND AND OBJECTIVES: Postdischarge treatment of complicated pneumonia includes a 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.
AB - BACKGROUND AND OBJECTIVES: Postdischarge treatment of complicated pneumonia includes a 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.
UR - http://www.scopus.com/inward/record.url?scp=85008312146&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85008312146&partnerID=8YFLogxK
U2 - 10.1542/peds.2016-1692
DO - 10.1542/peds.2016-1692
M3 - Article
C2 - 27940695
AN - SCOPUS:85008312146
VL - 138
JO - Pediatrics
JF - Pediatrics
SN - 0031-4005
IS - 6
M1 - e20161692
ER -