Complex Pneumonia Requires Simple Oral Antibiotic Therapy for Residual Disease

Highlights

• Residual pneumonia can be treated with oral antibiotic therapy instead of intravenous method
• 3.2% failure rate in intravenous method of drug delivery while treating children discharged from the hospital with 7.1% risk of complication.
• 2.6% failure rate in children on oral antibiotics with 0.6% adverse drug reaction.

A team of researchers from Cincinnati Children’s Hospital Medical Centre have found that children who are recovering from complex pneumonia can be treated with oral antibiotics. The oral antibiotics are a replacement to intravenous antibiotics that are generally prescribed to children during the recovery period when they are discharged home from the hospital. Among children with complex pneumonia, intravenous antibiotics are prescribed as a method of drug delivery for a period that ranges between 1 to 3 weeks during hospitalization, after which the child is normally, advised intravenous antibiotics even after discharge.

Now, however, the researchers claim that after intravenous antibiotics are administered during the period of hospitalization, children could be shifted to oral antibiotics on discharge from the hospital.

Residual Disease

A retrospective study was conducted on 2,123 children across 36 hospitals and it was found that oral antibiotics were as effective as intravenous antibiotics in managing residual pneumonia in children.

Limitations of Using Intravenous Antibiotics

• Chances of infection at the site of injection are high
• Flow rates need to be monitored diligently: Exceeding the flow rates could lead to complications.
• Children may move or shake during intravenous antibiotic therapy at home, resulting in injury
• Intravenous antibiotic therapy would require careful monitoring at home and sterile environment.

A child with residual disease and on oral antibiotics will be able to get back to normal routine faster than if intravenous antibiotics are administered at home. Moreover, the risk of complications during intravenous injections might require repeat hospitalization.

Dr. Samir Shah who is the lead author of the study said “PICC line complications can be serious, resulting in hospital readmission, additional procedures, and more medications, as well as missed work or school.” Cincinnati Children’s Director of Hospital Medicine, Dr. Shah further added “It’s not surprising that children and families would rather not use PICC lines. Our findings, which provide compelling evidence to support the use of oral antibiotics for children with complex pneumonia, will contribute to safer care for children across the country.”

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The prevalence of complex pneumonia is 15%, with these children requiring hospital care for a period of three weeks. After discharge, there is considerable variation in the prescribed medical care routine. Three fourth of the study participants were children who received intravenous antibiotics during hospitalization for complex pneumonia.

2,123 children were included in the study:

• 281 children, 13.6% of the children were prescribed intravenous antibiotics after they were discharged.
• 3.2% failure rate was noticed among children on a peripherally inserted central venous catheter (PICC)  line
• 2.6% failure rate was noticed among children on oral antibiotics.
• PICC associated complications were seen in 7.1% of the people.
• Drug related complications were seen in 0.6% of patients on oral antibiotics.

Complex Pneumonia

Complex pneumonia is a condition in which there is collection of fluid in the pleural space during an underlying infection of pneumonia.  In some cases there is pus in the pleural membrane. This type of complex pneumonia is generally seen in 6 to 8% of community acquired pneumonia.

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The most common cause of community acquired pneumonia is Streptococcus pneumonia. Other microorganisms that are known to cause this infection, but to a lesser extent, are Staphylococcus aureus, Mycobacterium tuberculosis and Helicobacter Sp.

Staphylococcus aureus is known to cause a more severe necrotizing form of disease along with increased empyema.

References:

1. Complicated Pneumomnia - (http://peds.stanford.edu/Rotations/blue_team/documents/Complicated_Pneumonia_Info.pdf)
2. CT and MR Angiography: Comprehensive Vascular Assessment; Geoffrey D Rubin et al;

Source-Medindia