Comparative effectiveness of intravenous vs oral antibiotics for Postdischarge treatment ofacuteosteomyelitis in children

Ron Keren, Samir S. Shah, Rajendu Srivastava, Shawn Rangel, Michael Bendel-Stenzel, Nada Harik, John Hartley, Michelle Lopez, Luis Seguias, Joel Tieder, Matthew Bryan, Wu Gong, Matt Hall, Russell Localio, Xianqun Luan, Rachel De Berardinis, Allison Parker, Chris Miller, Wendy Hoffner, Suchitra RaoDerek J. Williams, Cynthia D. Cross, Jeffrey Colvin, Susan Wu, Waheeda Samady, Paul Ishimine, Thomas A. Coffelt, Ben Bauer, Mythili Srinivasan, Ilana Waynik, Brett Anderson, Marcos Mestre, Adam Berkwitt, John Kinnison, Tiffany Shea Osburn, Bhanumathy Kumar, David Kotzbauer, George Hescock, Sheilah Snyder, Edward Chu, Sri Narayanan, Bahman Panbehi, Nader Shaikh, Rainer Gedeit, Marc Mazade, Kristen Sheets, Joni Oberlin

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

IMPORTANCE: Postdischarge treatment of acute osteomyelitis in children requires weeks of antibiotic therapy, which can be administered orally or intravenously via a peripherally inserted central catheter (PICC). The catheters carry a risk for serious complications, but limited evidence exists on the effectiveness of oral therapy. OBJECTIVE: To compare the effectiveness and adverse outcomes of postdischarge antibiotic therapy administered via the PICC or the oral route. DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective cohort study comparing PICC and oral therapy for the treatment of acute osteomyelitis. Among children hospitalized from January 1, 2009, through December 31, 2012, at 36 participating children's hospitals, we used discharge codes to identify potentially eligible participants. Results of medical record review confirmed eligibility and defined treatment group allocation and study outcomes.We used within- and across-hospital propensity score-based full matching to adjust for confounding by indication. INTERVENTIONS: Postdischarge administration of antibiotics via the PICC or the oral route. MAIN OUTCOMES AND MEASURES: The primary outcomewas treatment failure. Secondary outcomes included adverse drug reaction, PICC line complication, and a composite of all 3 end points. RESULTS: Among 2060 children and adolescents (hereinafter referred to as children) with osteomyelitis, 1005 received oral antibiotics at discharge, whereas 1055 received PICC-administered antibiotics. The proportion of children treated via the PICC route varied across hospitals from 0 to 100%. In the across-hospital (risk difference, 0.3%[95%CI, -0.1% to 2.5%]) and within-hospital (risk difference, 0.6%[95%CI, -0.2%to 3.0%]) matched analyses, children treated with antibiotics via the oral route (reference group) did not experience more treatment failures than those treated with antibiotics via the PICC route. Rates of adverse drug reaction were low (

Original languageEnglish (US)
Pages (from-to)120-128
Number of pages9
JournalJAMA Pediatrics
Volume169
Issue number2
DOIs
StatePublished - Feb 1 2015

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Catheters
Anti-Bacterial Agents
Osteomyelitis
Therapeutics
Drug-Related Side Effects and Adverse Reactions
Treatment Failure
Propensity Score
Hospitalized Child
Medical Records
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Keren, R., Shah, S. S., Srivastava, R., Rangel, S., Bendel-Stenzel, M., Harik, N., ... Oberlin, J. (2015). Comparative effectiveness of intravenous vs oral antibiotics for Postdischarge treatment ofacuteosteomyelitis in children. JAMA Pediatrics, 169(2), 120-128. https://doi.org/10.1001/jamapediatrics.2014.2822

Comparative effectiveness of intravenous vs oral antibiotics for Postdischarge treatment ofacuteosteomyelitis in children. / Keren, Ron; Shah, Samir S.; Srivastava, Rajendu; Rangel, Shawn; Bendel-Stenzel, Michael; Harik, Nada; Hartley, John; Lopez, Michelle; Seguias, Luis; Tieder, Joel; Bryan, Matthew; Gong, Wu; Hall, Matt; Localio, Russell; Luan, Xianqun; De Berardinis, Rachel; Parker, Allison; Miller, Chris; Hoffner, Wendy; Rao, Suchitra; Williams, Derek J.; Cross, Cynthia D.; Colvin, Jeffrey; Wu, Susan; Samady, Waheeda; Ishimine, Paul; Coffelt, Thomas A.; Bauer, Ben; Srinivasan, Mythili; Waynik, Ilana; Anderson, Brett; Mestre, Marcos; Berkwitt, Adam; Kinnison, John; Osburn, Tiffany Shea; Kumar, Bhanumathy; Kotzbauer, David; Hescock, George; Snyder, Sheilah; Chu, Edward; Narayanan, Sri; Panbehi, Bahman; Shaikh, Nader; Gedeit, Rainer; Mazade, Marc; Sheets, Kristen; Oberlin, Joni.

In: JAMA Pediatrics, Vol. 169, No. 2, 01.02.2015, p. 120-128.

Research output: Contribution to journalArticle

Keren, R, Shah, SS, Srivastava, R, Rangel, S, Bendel-Stenzel, M, Harik, N, Hartley, J, Lopez, M, Seguias, L, Tieder, J, Bryan, M, Gong, W, Hall, M, Localio, R, Luan, X, De Berardinis, R, Parker, A, Miller, C, Hoffner, W, Rao, S, Williams, DJ, Cross, CD, Colvin, J, Wu, S, Samady, W, Ishimine, P, Coffelt, TA, Bauer, B, Srinivasan, M, Waynik, I, Anderson, B, Mestre, M, Berkwitt, A, Kinnison, J, Osburn, TS, Kumar, B, Kotzbauer, D, Hescock, G, Snyder, S, Chu, E, Narayanan, S, Panbehi, B, Shaikh, N, Gedeit, R, Mazade, M, Sheets, K & Oberlin, J 2015, 'Comparative effectiveness of intravenous vs oral antibiotics for Postdischarge treatment ofacuteosteomyelitis in children', JAMA Pediatrics, vol. 169, no. 2, pp. 120-128. https://doi.org/10.1001/jamapediatrics.2014.2822
Keren, Ron ; Shah, Samir S. ; Srivastava, Rajendu ; Rangel, Shawn ; Bendel-Stenzel, Michael ; Harik, Nada ; Hartley, John ; Lopez, Michelle ; Seguias, Luis ; Tieder, Joel ; Bryan, Matthew ; Gong, Wu ; Hall, Matt ; Localio, Russell ; Luan, Xianqun ; De Berardinis, Rachel ; Parker, Allison ; Miller, Chris ; Hoffner, Wendy ; Rao, Suchitra ; Williams, Derek J. ; Cross, Cynthia D. ; Colvin, Jeffrey ; Wu, Susan ; Samady, Waheeda ; Ishimine, Paul ; Coffelt, Thomas A. ; Bauer, Ben ; Srinivasan, Mythili ; Waynik, Ilana ; Anderson, Brett ; Mestre, Marcos ; Berkwitt, Adam ; Kinnison, John ; Osburn, Tiffany Shea ; Kumar, Bhanumathy ; Kotzbauer, David ; Hescock, George ; Snyder, Sheilah ; Chu, Edward ; Narayanan, Sri ; Panbehi, Bahman ; Shaikh, Nader ; Gedeit, Rainer ; Mazade, Marc ; Sheets, Kristen ; Oberlin, Joni. / Comparative effectiveness of intravenous vs oral antibiotics for Postdischarge treatment ofacuteosteomyelitis in children. In: JAMA Pediatrics. 2015 ; Vol. 169, No. 2. pp. 120-128.
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abstract = "IMPORTANCE: Postdischarge treatment of acute osteomyelitis in children requires weeks of antibiotic therapy, which can be administered orally or intravenously via a peripherally inserted central catheter (PICC). The catheters carry a risk for serious complications, but limited evidence exists on the effectiveness of oral therapy. OBJECTIVE: To compare the effectiveness and adverse outcomes of postdischarge antibiotic therapy administered via the PICC or the oral route. DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective cohort study comparing PICC and oral therapy for the treatment of acute osteomyelitis. Among children hospitalized from January 1, 2009, through December 31, 2012, at 36 participating children's hospitals, we used discharge codes to identify potentially eligible participants. Results of medical record review confirmed eligibility and defined treatment group allocation and study outcomes.We used within- and across-hospital propensity score-based full matching to adjust for confounding by indication. INTERVENTIONS: Postdischarge administration of antibiotics via the PICC or the oral route. MAIN OUTCOMES AND MEASURES: The primary outcomewas treatment failure. Secondary outcomes included adverse drug reaction, PICC line complication, and a composite of all 3 end points. RESULTS: Among 2060 children and adolescents (hereinafter referred to as children) with osteomyelitis, 1005 received oral antibiotics at discharge, whereas 1055 received PICC-administered antibiotics. The proportion of children treated via the PICC route varied across hospitals from 0 to 100{\%}. In the across-hospital (risk difference, 0.3{\%}[95{\%}CI, -0.1{\%} to 2.5{\%}]) and within-hospital (risk difference, 0.6{\%}[95{\%}CI, -0.2{\%}to 3.0{\%}]) matched analyses, children treated with antibiotics via the oral route (reference group) did not experience more treatment failures than those treated with antibiotics via the PICC route. Rates of adverse drug reaction were low (",
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AU - Keren, Ron

AU - Shah, Samir S.

AU - Srivastava, Rajendu

AU - Rangel, Shawn

AU - Bendel-Stenzel, Michael

AU - Harik, Nada

AU - Hartley, John

AU - Lopez, Michelle

AU - Seguias, Luis

AU - Tieder, Joel

AU - Bryan, Matthew

AU - Gong, Wu

AU - Hall, Matt

AU - Localio, Russell

AU - Luan, Xianqun

AU - De Berardinis, Rachel

AU - Parker, Allison

AU - Miller, Chris

AU - Hoffner, Wendy

AU - Rao, Suchitra

AU - Williams, Derek J.

AU - Cross, Cynthia D.

AU - Colvin, Jeffrey

AU - Wu, Susan

AU - Samady, Waheeda

AU - Ishimine, Paul

AU - Coffelt, Thomas A.

AU - Bauer, Ben

AU - Srinivasan, Mythili

AU - Waynik, Ilana

AU - Anderson, Brett

AU - Mestre, Marcos

AU - Berkwitt, Adam

AU - Kinnison, John

AU - Osburn, Tiffany Shea

AU - Kumar, Bhanumathy

AU - Kotzbauer, David

AU - Hescock, George

AU - Snyder, Sheilah

AU - Chu, Edward

AU - Narayanan, Sri

AU - Panbehi, Bahman

AU - Shaikh, Nader

AU - Gedeit, Rainer

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AU - Oberlin, Joni

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