title: Intravenous Versus Oral Antibiotics for Postdischarge Treatment of Complicated Pneumonia.
abstract: Postdischarge treatment of complicated pneumonia includes antibiotics administered intravenously via a peripherally inserted central venous catheter (PICC) or orally. Antibiotics administered via PICC, although effective, may result in serious complications. We compared the effectiveness and treatment-related complications of postdischarge antibiotics delivered by these 2 routes.
  
  
  
  This multicenter retrospective cohort study included children ≥2 months and <18 years discharged with complicated pneumonia between 2009 and 2012. The main exposure was the route of postdischarge antibiotic administration, classified as PICC or oral. The primary outcome was treatment failure. Secondary outcomes included PICC complications, adverse drug reactions, other related revisits, and a composite of all 4 outcomes, termed "all related revisits."
  
  
  
  Among 2123 children, 281 (13.2%) received antibiotics via PICC. Treatment failure rates were 3.2% among PICC and 2.6% among oral antibiotic recipients and were not significantly different between the groups in across-hospital-matched analysis (matched odds ratio [OR], 1.26; 95% confidence interval [CI], 0.54 to 2.94). PICC complications occurred in 7.1%. Adverse drug reactions occurred in 0.6% of children; PICC antibiotic recipients had greater odds of adverse drug reaction in across hospital matched analysis (matched OR, 19.1; 95% CI, 4.2 to 87.3). The high rate of PICC complications and differences in adverse drug reactions contributed to higher odds of the composite outcome of all related revisits among PICC antibiotic recipients (matched OR, 4.71; 95% CI, 2.97 to 7.46).
  
  
  
  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.
authors.affiliation: Divisions of Hospital Medicine and samir.shah@cchmc.org.|Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.|Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Division of Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.|Institute for Healthcare Delivery Research and Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, Utah.
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
authors.affiliation: Division of Hospital Medicine, Children's Hospital of Los Angeles, Los Angeles, California.|Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California.
authors.forename: Susan
authors.initials: S
authors.lastname: Wu
authors.affiliation: Division of General Academic Pediatrics, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Colvin
authors.affiliation: Division of Hospital Medicine, Monroe Carrell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.|Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Williams
authors.affiliation: Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
authors.affiliation: Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.|Northwestern Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Waheeda
authors.initials: W
authors.lastname: Samady
authors.affiliation: Division of Infectious Diseases and of Hospital Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.|Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado.
authors.forename: Suchitra
authors.initials: S
authors.lastname: Rao
authors.affiliation: Division of Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Christopher
authors.initials: C
authors.lastname: Miller
authors.affiliation: Division of Pediatric Hospital Medicine, LeBonheur Children's Hospital, Memphis, Tennessee.|Department of Pediatrics, University of Tennessee College of Medicine, Memphis, Tennessee.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Cross
authors.affiliation: Divisions of Hospital Medicine and.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Clohessy
authors.affiliation: Children's Hospital Association, Overland Park, Kansas.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.affiliation: Department of Biostatistics and Epidemiology, Perlman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Russell
authors.initials: R
authors.lastname: Localio
authors.affiliation: Department of Biostatistics and Epidemiology, Perlman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bryan
authors.affiliation: Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Gong
authors.initials: G
authors.lastname: Wu
authors.affiliation: Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.|Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Ron
authors.initials: R
authors.lastname: Keren
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006801:Humans; D007223:Infant; D010351:Patient Discharge; D011014:Pneumonia / Q000188:drug therapy*; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents