Early Switch From IV to Oral Meds Effective for Children with Acute Bone Infection

When treating hospitalized children with acute osteomyelitis -- a bacterial bone infection -- an early changeover from intravenous (IV) antibiotic delivery to oral antibiotics is just as effective as continuing the IV therapy, according to pediatric researchers.

In addition, the oral drugs are more convenient for children and families, and avoid a major drawback of IV use: increased risk of complications from using central catheters, such as infections or breaks in the catheter.

A study team from The Children's Hospital of Philadelphia analyzed hospital records for nearly 2,000 children treated at 29 U.S. pediatric hospitals between 2000 and 2005. Their report appeared in the February issue of Pediatrics. "There had been previous reports with small numbers of patients suggesting that early transition to oral antibiotics was safe and effective," said study leader Theoklis Zaoutis, MD, MSCE, an infectious diseases specialist at the Center for Pediatric Clinical Effectiveness of Children's Hospital. "This was the first large study of outcomes to directly compare the two practices."

Acute osteomyelitis annually affects at least one in 5,000 children under age 13 in the United States, and results in one percent of all pediatric hospitalizations. Typically caused by the common bacteria Staphylococcus aureus, osteomyelitis usually appears as a fever with some discomfort in a child's leg or arm resulting from the bone infection. The average age of children with the condition is 5 years.

The traditional treatment has been to supply antibiotics through a central venous catheter over a four- to six-week period after the child returns home from the hospital. Alternatively, children are first treated with IV antibiotics for less than a week, then sent home with oral antibiotics.

In the current study, some 5 percent of the 1,021 children receiving the prolonged IV antibiotic had to return to the hospital for further treatment, compared to 4 percent of the 948 children receiving oral medicine. "The risk of treatment failure was not significantly different between the two groups," said Zaoutis, "but approximately 4 percent, of the children receiving the prolonged IV therapy had complications related to the central venous catheter."

Zaoutis's study found wide variability in hospital practices, with some children's hospitals switching over 90 percent of their osteomyelitis patients to oral drugs, and other hospitals using early transition in less than 10 percent of patients. "This study provides evidence that hospitals can orient their clinical guidelines toward early transition to oral medication for acute osteomyelitis in children," added Zaoutis. He cautioned that the study focused on children with uncomplicated infections, and switching to oral therapy may not be appropriate for complicated infections or chronic osteomyelitis.

Zaoutis receives support from the National Institutes of Health, and the Agency for Healthcare Research and Quality provided grant support for this research. Zaoutis's co-authors were Ron Keren, MD, MPH, A. Russell Localio, PhD, Kateri Leckerman, MS, and Stephanie Saddlemire, MSPH, all of Children's Hospital; and David Bertoch, MHA, of the Child Health Corporation of America, Shawnee Mission, Kans. Zaoutis, Localio, and Keren also are on the faculty of the University of Pennsylvania School of Medicine.