Oral Antibiotics Preferred for Pediatric Pneumonia

Children with complicated pneumonia should be discharged from the hospital with oral instead of intravenous (IV) antibiotics when possible, according to a new study.

Researchers at Cincinnati Children's Hospital (OH, USA), the University of Pennsylvania (PA, USA), and other institutions conducted a multicenter retrospective cohort study of data from the Pediatric Health Information System (PHIS) to compare effectiveness and treatment-related complications of post-discharge antibiotics administered via a peripherally inserted central venous catheter (PICC), or administered orally. The study included 2,123 children from 36 hospitals who received oral (1,842) and PICC (281) antibiotics that were discharged with complicated pneumonia between 2009 and 2012.

The results showed no significant differences in treatment failure rates between PICC and oral antibiotics. Conversely, children discharged with PICCs experienced a higher rate of infections, adverse drug reactions, and hospital readmissions, with PICC complications occurring in 7.1% of children who received intravenous antibiotics. In addition, 17.8% of the children who received IV antibiotics required unplanned or emergency care, compared with only 3.1% of children who received oral antibiotics. The study was published on November 17, 2016, in Pediatrics.

“Children with complicated pneumonia typically require prolonged antibiotic therapy, 2 to 4 weeks in total, much of which is administered after hospital discharge. Our study demonstrates that oral antibiotics are just as effective as intravenous antibiotics, but with fewer treatment-associated complications,” said lead author Samir Shah, MD, of Cincinnati Children's Hospital. “This means that most children with complicated pneumonia can safely be discharged with antibiotics by mouth, avoiding the pain and potential complications associated with PICC lines.”

“One other factor to consider is that some antibiotics such as vancomycin can only be given by PICC. It is possible that the higher rate of adverse drug reactions in the PICC group, such as drug fever or low blood counts, were related to type of antibiotic used, rather than how it was given,” concluded Dr. Shah. “The reality is that one should consider the higher rate of adverse drug reactions in the PICC group, regardless of the reason, as one more factor favoring the use of antibiotics by mouth for complicated pneumonia.”

Related Links:
Cincinnati Children's Hospital
University of Pennsylvania