Child/Adolescent Health

Children with acute bone infections can be switched from intravenous to oral antibiotics before hospital discharge

Osteomyelitis, a bacterial infection of the bone, accounts for 1 percent of all pediatric hospitalizations in the United States. Children can contract these infections from blood infections, penetrating trauma, or when an infection spreads to the bone from a nearby site. Until recently, experts have recommended that these children receive 4 to 6 weeks of intravenous antibiotics through a central venous catheter. However, a new study found that these children fare just as well when given a shorter course of intravenous antibiotics followed by oral antibiotics for the same period of treatment. The potential benefits of switching children to oral antibiotics prior to hospital discharge include lower cost, increased convenience, and reduced risk of complications linked to prolonged insertion of central venous catheters, explain researchers at the University of Pennsylvania Center for Education and Research on Therapeutics (CERT).

The researchers retrospectively studied the antibiotic treatment of children (aged 2 months to 17 years) diagnosed with acute uncomplicated osteomyelitis between 2000 and 2005 at 29 U.S. children's hospitals. They looked at type of treatment and reason for rehospitalization within 6 months of initial diagnosis. Of the 1,969 children studied, 1,021 received prolonged intravenous therapy and 948 were switched to oral therapy before hospital discharge. The use of prolonged intravenous therapy varied significantly across hospitals, ranging from 10 to 95 percent of children treated.

Children in both groups had similar characteristics and similar severity of illness. Overall, 5 percent of children who received prolonged intravenous antibiotics were rehospitalized compared with 4 percent of the oral antibiotic group. However, this was not a significant difference. Additionally, 3.4 percent of children in the prolonged intravenous therapy group were readmitted for a catheter-associated complication. Also, rates of readmission for antimicrobial complications were significantly higher in the prolonged intravenous treatment group.

This study was funded in part by a grant from the Agency for Healthcare Research and Quality (HS10399) to the University of Pennsylvania CERT. For more information on the CERTs program, visit http://certs.hhs.gov/index.html.

See "Prolonged intravenous therapy versus early transition to oral antimicrobial therapy for acute osteomyelitis in children," by Theoklis Zaoutis, M.D., M.S.C.E., A. Russell Localio, Ph.D., Kateri Leckerman, M.S., and others, in the February 2009 Pediatrics 123(2), pp. 636-643.

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