Intravenous Versus Oral Antibiotics for Postdischarge Treatment of Complicated Pneumonia

Shah, Samir S.; Srivastava, Rajendu; Wu, Susan; Colvin, Jeffrey D.; Williams, Derek J.; Rangel, Shawn J.; Samady, Waheeda; Rao, Suchitra; Miller, Christopher; Cross, Cynthia; Clohessy, Caitlin; Hall, Matthew; Localio, Russell; Bryan, Matthew; Gong, Wu; Keren, Ron

doi:10.1542/peds.2016-1692

Cited by 50 publications

(37 citation statements)

References 21 publications

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“…This was confirmed by another retrospective cohort study evaluating 2132 children with empyema. Treatment failure rates were identical in both groups: PICC 3.2%, and orally 2.6% [75]. Currently, there is no evidence recommending specific antimicrobial therapy.…”

Section: Pleural Empyemamentioning

confidence: 79%

Childhood community-acquired pneumonia: A review of etiology- and antimicrobial treatment studies

Tramper-Stranders

2018

Paediatric Respiratory Reviews

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Community acquired pneumonia (CAP) is a leading cause of childhood morbidity worldwide. Because of the rising antimicrobial resistance rates and adverse effects of childhood antibiotic use on the developing microbiome, rational prescribing of antibiotics for CAP is important. This review summarizes and critically reflects on the available evidence for the epidemiology, etiology and antimicrobial management of childhood CAP. Larger prospective studies on antimicrobial management derive mostly from low- or middle-income countries as they have the highest burden of CAP. Optimal antimicrobial management depends on the etiology, age, local vaccination policies and resistance patterns. As long as non-rapid surrogate markers are used to distinguish viral- from bacterial pneumonia, the management is probably suboptimal. For a young child with signs of non-severe pneumonia (with or without wheezing), watchful waiting is recommended because of probable viral etiology. For children with more severe CAP with fever, a five-day oral amoxicillin course would be the first choice therapy and dosage will depend on local resistance rates. There is no clear evidence yet for superiority of a macrolide-based regimen for all ages. For cases with CAP requiring hospitalization, several studies have shown that narrow-spectrum IV beta-lactam therapy is as effective as a broad-spectrum cephalosporin therapy. For most severe disease, broad-spectrum therapy with or without a macrolide is suggested. In case of empyema, rapid IV-to-oral switch seems to be equivalent to prolonged IV treatment.

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Section: Pleural Empyemamentioning

confidence: 79%

Childhood community-acquired pneumonia: A review of etiology- and antimicrobial treatment studies

Tramper-Stranders

2018

Paediatric Respiratory Reviews

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“…Nevertheless, guidelines remain valuable to help reduce short term morbidity, minimize risk, and promote antibiotic stewardship. Although published guidelines on complicated pneumonia in children are now several years old, recent research suggests that they are still relevant . However, further studies are needed to help resolve unanswered questions and ensure that guidelines remain applicable as care changes with time, particularly introduction of effective pneumococcal vaccines.…”

Section: Discussionmentioning

confidence: 99%

“…There is no consensus on the appropriate length of therapy for complicated pneumonia, with expert recommendations favoring a switch from parenteral to oral therapy after resolution of fever, with a further 1 to 4 weeks of treatment . Longer courses of intravenous antibiotic therapy do not appear to improve outcomes and can be associated with increased complications …”

Section: Treatmentmentioning

confidence: 99%

American Thoracic Society 2019 Pediatric Core Curriculum

Moore

Boyer

Perkins

et al. 2019

Pediatric Pulmonology

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The American Thoracic Society Pediatric Core Curriculum updates clinicians annually in pediatric pulmonary disease in a 3 to 4 year recurring cycle of topics. The 2019 course was presented in May during the Annual International Conference. An American Board of Pediatrics Maintenance of Certification module and a continuing medical education exercise covering the contents of the Core Curriculum can be accessed online at http://www.thoracic.org.

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“…A multicentre retrospective US study of 2123 children aged 2 months to 18 years compared treatment failure who postdischarge received antibiotics orally or through a peripherally inserted central catheter (PICC) for a median of 14 days. 1 Pleural drainage was performed in 43.9% of children. Treatment failures occurred in 3.2% of PICC and 2.6% of oral recipients.…”

Section: Post-discharge Antibiotic Treatment Of Complicated Pneumoniamentioning

confidence: 99%

Presenting symptoms and signs of acute leukaemia

Isaacs

2017

J Paediatrics Child Health

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Presenting symptoms and signs of acute leukaemiaChildren with acute leukaemia often present initially to general practitioners or general paediatricians. The clinical features are protean, and the diagnosis may be difficult. A systematic review and meta-analysis of presenting features identified 33 studies of 3084 subjects, who presented with 95 signs and symptoms. Only 6% of children were asymptomatic at diagnosis. The review identified five features each present in over half of the children: hepatomegaly (64%), splenomegaly (61%), pallor (53%), fever (53%) and bruising (52%). Features present in one-third to half were recurrent infections, fatigue, limb pain, bruising/petechiae, lymphadenopathy, bleeding tendency and rash. Abdominal symptoms of anorexia or weight loss (29%), abdominal pain (12%) or distension (11%) were more common than generally recognised. Mucosal bleeding occurred in 25%, while musculoskeletal symptoms included limp (15%) or joint pain (11%). Multiple signs and symptoms were common. These clinical signs may occur in other conditions, but this paper alerts clinicians to signs and symptoms that should rouse suspicion, and prompt them to at least order a blood film.

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Intravenous Versus Oral Antibiotics for Postdischarge Treatment of Complicated Pneumonia

Abstract: 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.

Cited by 50 publications

References 21 publications

Childhood community-acquired pneumonia: A review of etiology- and antimicrobial treatment studies

Childhood community-acquired pneumonia: A review of etiology- and antimicrobial treatment studies

American Thoracic Society 2019 Pediatric Core Curriculum

Presenting symptoms and signs of acute leukaemia

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