Oral Therapy Preferred for Discharged Children with Osteomyelitis

Pediatric osteomyelitis patients who receive oral antibiotics after discharge do not fare any worse than children treated intravenously, according to a study published in JAMA Pediatrics.

Osteomyelitis is a serious bacterial bone infection that is typically treated intravenously, though oral antibiotics are an appealing albeit unstudied alternative. The peripherally inserted central catheter (PICC) performs well in delivering antibiotic concentrations, but such intravenous (IV) treatment is associated with serious complications, including infections and blood clots.

In light of those facts, researchers from the Children’s Hospital of Philadelphia aimed to examine how children with osteomyelitis receive outpatient antibiotic therapy and the ways in which it affects them and their caregivers.

For the study, the investigators studied 2060 children discharged from 36 hospitals between 2009 and 2012 who were diagnosed with osteomyelitis. Half of the children received oral antibiotics following discharge, while the other half remained in the hospital and were given antibiotics through a PICC.

Children treated with outpatient oral antibiotics did not demonstrate more treatment failures than those treated with antibiotics through a PICC, and both patient cohorts experienced low rates of adverse drug reactions. However, 158 patients (15%) in the PICC group had a related complication for which they were sent to the emergency department, readmitted to the hospital, or both.

“Given the magnitude…and gravity…of the PICC-related complications, clinicians should reconsider the practice of treating otherwise healthy children with osteomyelitis with prolonged IV therapy when an effective oral alternative exists,” the authors concluded.

In an accompanying editorial, Pranita D. Tamma, MD, MHS, and Aaron M. Milstone, MD, MHS, from the Johns Hopkins University School of Medicine explained that, “In the absence of data demonstrating that long-term IV antibiotics enhance clinical outcomes compared with oral therapy, clinicians should strongly consider transition to oral antibiotic therapy at the time of discharge for the treatment of acute osteomyelitis in otherwise healthy children.”

“In summary, this study addresses an important question with obvious implications for children and their caregivers hoping to avoid PICC-associated complications,” the editorial writers commented.