Oral, Intravenous Antibiotics Equally Effective at Treating Bone Infection

Dec 15 2014

Oral, Intravenous Antibiotics Equally Effective at Treating Bone Infection

osteomyelitisThe Children’s Hospital of Philadelphia’s Ron Keren, MD, MPH, was the first author of a study published today in JAMA Pediatrics that showed treating the bone infection osteomyelitis with oral antibiotics did not result in more treatment failures than treatment with intravenous antibiotics. As a result, the researchers suggest physicians reconsider using intravenous antibiotics to treat this condition because of that treatment method’s complications.

A serious infection of the bone, osteomyelitis affects approximately 1 in 5000 children per year. Osteomyelitis can require multi-week regimens of antibiotics, often given intravenously, and in some cases the condition can lead to surgery to remove dead bone tissue.

In 2012 Dr. Keren and colleagues received an award from the Patient-Centered Outcomes Research Institute to study treatment of serious bacterial infections with antibiotics. In collaboration with researchers from Pediatric Research in Inpatient Settings Network-affiliated institutions and the Children’s Hospital Association, Dr. Keren and colleagues have been comparing oral antibiotics to those delivered via a peripherally inserted central catheter, or PICC line.

PICC lines are preferred by many clinicians for long-term treatment of severe infections, but often require sedation for insertion, need regular maintenance, and can clot, break, or become dislodged.

Oral antibiotics, on the other hand, are much easier for patients to take and caregivers to manage. However, to achieve the same efficacy as IV medications oral antibiotics must have high “bioavailability” — that is, the amount of medicine absorbed into the blood through the digestive tract needs to be high.  By definition, all antibiotics administered through PICC lines have 100 percent bioavailability, but only some oral antibiotics have high bioavailability.

In the JAMA Pediatrics study, Dr. Keren and colleagues — including Samir S. Shah, MD, MSCE, from Cincinnati Children’s Hospital — coordinated a retrospective review of medical records of children who were hospitalized between January 1, 2009 and December 31, 2012 across 36 children’s hospitals. The patients were split into two groups, one that received antibiotics via a PICC line, and another group that received antibiotics orally.

The investigators found similar treatment failure rates across the PICC and oral groups, at 4 and 5 percent, respectively. Adverse drug reactions were similarly low, at less than 4 percent in both groups. But the research group found that of children who received PICC lines, 15 percent developed a PICC-related complication, such as a blood stream infection, clot, or dislodgement that required a visit to an emergency department, rehospitalization, or both.

“PICC complications such as blood clots and blood stream infections are quite serious. We can avoid such complications by using oral antibiotics,” said Dr. Shah, a hospitalist and infectious diseases specialist.

Overall, the researchers showed children prescribed oral antibiotics did not have higher rates of treatment failure than did their peers who received antibiotics via a PICC line.

“Once a bone infection improves after a few days of intravenous antibiotics, children can be transitioned to oral antibiotics and have excellent outcomes, without the hassles and potential complications of PICC therapy,” Dr. Keren said.

To read more about Dr. Keren et al.’s antibiotics project, see the Pediatric Research in Inpatient Settings Network page about it. For more information about this study, see JAMA Pediatrics.